CPT ® Code Changes for 2016
Academic Medicine, MultiSpecialty Based Medicine and
Office-based Practices
Stephanie Johnson, MHA, CHC, RHIT, CPC, CPEDS
Compliance
McKesson Business Performance Services
This commentary is a summary prepared by McKesson’s Business Performance Services division and highlights certain changes, but not
all changes, in 2016 CPT® codes relating to all specialties excluding Pathology/Laboratory, Radiology, Emergency Medicine and
Anesthesia. This commentary does not supplant the American Medical Association’s (AMA) current listing of CPT® codes, its
documentation in the annual CPT® Changes publications, and other related publications from the AMA, which are the authoritative source
for information about CPT® codes. Please refer to your 2016 CPT® Code Book, annual CPT® Changes publication, HCPCS Book and
Payer Bulletins for additional information, including additions, deletions, changes and interpretations that may not be reflected in this
document.
CPT® is a registered trademark of the AMA. The AMA is the owner of all copyright, trademark and other rights to CPT® and its updates.
CPT® codes, descriptions and other data are copyright 1966, 1970, 1973, 1977, 1981, 1983-2015 AMA. All rights reserved.
1
OVERVIEW
®
To provide details on the 2016 CPT changes, McKesson (BPS) has prepared this summary of new, deleted
and revised codes for all specialties excluding Pathology/Laboratory, Radiology, Emergency Medicine, and
Anesthesia issued by the American Medical Association (AMA).
All individuals should understand the various code symbols that AMA uses to denote new codes, revised
codes, deleted codes, resequenced codes, etc. You should look under the Code Symbols section of the
introduction in the code book for definitions and explanations of the various symbols.
Each year, the AMA publishes its new, revised and deleted CPT codes for that calendar year. This document
is to provide a summary of the changes on the following specialties: Evaluation and Management, Surgery,
Medicine, Category II, and Category III codes.
SUMMARY REVIEW
Section
E/M
Surgery
Medicine
Category II
Category III
New
2
48
14
0
27
Revised
2
14
50
1
2
Deleted
0
22
19
0
14
EVALUATION AND MANAGEMENT
In the Evaluation and Management (E/M) Services section, changes include the addition of a new subsection,
guidelines, and two new codes (99415, 99416) to describe prolonged office observation care services provided
by clinical staff in conjunction with physician or other qualified health care professional E/M services and
psychotherapy services. The guidelines for the Prolonged Services subsection have been revised to reference
the use of the new prolonged clinical staff services codes, as well as to provide instructions regarding how to
report psychotherapy services. In addition, editorial revisions to the guidelines for Preventive Medicine
Services and Counseling Risk Factor Reduction and Behavior Change Intervention have been made to clarify
the use of behavior change intervention codes 99406-99409 and the use of modifier 25.
1
Prolonged Codes
Revised
Description
Codes
99354
Prolonged evaluation and management or
psychotherapy service(s) (beyond the typical service time of the primary procedure) in the
office or other outpatient setting requiring direct patient contact beyond the usual service;
first hour (List separately in addition to code for office or other outpatient Evaluation and
Management or psychotherapy service)
each additional 30 minutes (List separately in addition to code for prolonged service)
99355
New
Codes
99415
99416
1
Description
Prolonged evaluation and management or psychotherapy service(s) (beyond the typical
service time of the primary procedure) in the office or other outpatient setting requiring
direct patient contact beyond the usual service; first hour (List separately in addition to
code for office or other outpatient Evaluation and Management or psychotherapy service)
each additional 30 minutes (List separately in addition to code for prolonged service)
2016 CPT Professional Edition, AMA, Page 32-33
2
The Prolonged Service With Direct Patient Contact subsection has been revised, beginning with the revision of
the instructional guidelines and the revision of codes 99354 and 99355. Two instructional parentheticals have
also been revised, and four have been added. In addition, a new subsection titled “Prolonged Clinical Staff
Services With Physician or Other Qualified Health Care Professional Supervision” has been added, along with
new instructional guidelines, two new codes (99415, 99416), and new parentheticals to report prolonged
clinical observation services in the outpatient or office setting.
Prior to 2016, codes 99354 and 99355 were the only codes that could be reported for prolonged face-to-face
services with the patient. These services, however, implied that the physician or other qualified healthcare
professional was providing the service. The guideline and procedure code changes have been made to allow
the reporting of office observation care services provided by clinical staff in conjunction with the services
provided by the physician or other qualified healthcare professional in providing the primary procedure(s) for
the patient. Because office observation care was ordinarily included as part of the Office or Other Outpatient
Services (identified as part of the pre-or post-service effort included in the visit by the physician or other
qualified healthcare professional), no codes existed to identify circumstances in which the physician’s staff was
required to provide effort beyond the typical time for circumstances that required observation (eg, after the
administration of a new medication or after the use of an inhaled drug to ensure patient safety). In these
circumstances, although the physician is responsible for the care of the patient, these services do not require
face-to-face time by the physician or other qualified healthcare professional. Instead, the effort of observing the
patient beyond the time ordinarily included within the E/M service is provided by the clinical staff. The
development of new codes 99415 and 99416 allows a method for reporting face-to-face services that only
require face-to-face observation by clinical staff under the supervision of a physician or other qualified
healthcare professional under specifically noted circumstances.
Two major areas have been revised to effect the changes made in this section.
The addition of the new subsection, guidelines, and two new codes allow reporting of the “new” services. This
includes the addition of codes 99415 and 99416 to identify prolonged clinical staff time of one hour (99415)
and each additional half hour of prolonged clinical staff time (99416). The instructional guidelines that precede
the new subsection educate users regarding the intended use of these codes. They also provide instruction
regarding when these codes may be reported (i.e., after the first 45 minutes of clinical staff time). In addition,
the parentheticals that follow these codes identify when the codes may be reported in conjunction with other
codes, and when codes 99415 and 99416 are excluded from use with codes 99354 and 99355. A table has
also been added to provide guidance to users regarding the time duration that should be used to identify which
codes may be reported.
Revision of the guidelines and existing codes 99354 and 99355 in the Prolonged Service With Direct Patient
Contact subsection clarifies when new codes 99415 and 99416 should be reported in place of codes 99354
and 99355, which are intended to be reported only by a physician or other qualified healthcare professional
who provides service beyond the usual E/M service. Changes to the code descriptor include the addition of
language to clarify that codes 99354 and 99355 are intended to be used in conjunction with E/M services, as
well as psychotherapy services (with removal of language that implied use for other “primary procedure[s]”).
Codes 99354 and 99355 are intended to report prolonged services that are provided by a physician or other
qualified healthcare professional. Codes 99415 and99416 are intended to report when prolonged services
beyond the initial 45 minutes are provided by clinical staff. (Clinical staff–time of less than 45 minutes is not
separately identified as this is inherently included as part of the existing E/M services.) Physician or other
qualified healthcare professional supervision is required for the use of codes 99415 and 99416. Because these
services are intended for outpatient settings, these codes are not intended for use in the inpatient setting.
3
2
Preventative Medicine Services
Subsection Guideline Revision
New Patient
CPT 99381: Initial comprehensive preventive medicine E/M of an individual including an age and gender
appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the
ordering of laboratory/diagnostic procedures, new patient; infant (age younger than 1 year)
The Preventive Medicine Services subsection guidelines have been revised to clarify that the Behavior Change
Intervention codes (99406-99409) are to be reported separately when performed on the same day as an E/M
service.
In the Preventive Medicine Services subsection, the revisions align the guidelines with the original intent of the
Behavior Change Intervention codes when they were added in 2008, which was to allow the separate reporting
of an E/M service, including the Preventive Medicine Services codes. As stated in the Counseling Risk Factor
Reduction and Behavior Change Intervention guidelines, “Any E/M services reported on the same day must be
distinct, and time spent providing these services may not be used as a basis for the E/M code selection.”
However, the Preventive Medicine Services guidelines were never revised when codes 99406-99409 were
added to the CPT code set. Thus, the Behavior Change Intervention codes were inadvertently included in the
listed range of codes specifically not separately reportable from the Preventive Medicine Services codes. This
Preventive Medicine Services guideline revision extracts the Behavior Change Intervention codes from this list
of codes not separately reportable with Preventive Medicine Services codes. The revision also places a crossreference parenthetical directing users to the specific codes for Behavior Change Intervention.
3
Counseling Risk Factor Reduction and Behavior Change Intervention
Subsection Guideline Revision
New or Established Patient
The Counseling Risk Factor Reduction and Behavior Change Intervention subsection guidelines have been
revised to add instruction to append modifier 25 when reporting E/M services on the same day as the
Counseling Risk Factor Reduction and Behavior Change Intervention codes.
This addition enforces already existing guidelines that state that these services are distinct from any E/M
service reported on the same day. However, clearly stating that modifier 25 should be appended clarifies
that, when performed, the E/M service must meet the definition of modifier 25 in that a significant, separately
identifiable E/M service was performed on the same day of the procedure or other service.
SURGERY
In the Surgery section, numerous changes have been made, starting with expansion of the guidelines to
include instructions for the use of “imaging guidance.” In the Integumentary System subsection, two new codes
(10035, 10036) for soft tissue marker placement with imaging were added, and one code was deleted in the
Musculoskeletal System subsection.
The Respiratory System subsection contains new guidelines, parenthetical notes, and three new codes
(31652, 31653, 31654) for reporting bronchoscopy utilizing transendoscopic endobronchial ultrasound. The
Cardiovascular System subsection also contains new guidelines for the Pacemaker or Implantable Defibrillator
subsection and includes refinements and new instructions pertaining to the use of new Category III codes and
new code 33477 for reporting transcatheter pulmonary valve implantation. A new diagram to describe reporting
of ECMO/ECLS procedures has also been added.
2
3
Ibid at Page 37.
Ibid at Page 38.
4
In the Intravascular Ultrasound Services subsection, guidelines have been expanded to clarify that
intravascular ultrasound is included in codes 37191, 37192, 37193, and 37197. Codes 37250 and 37251 have
been deleted and replaced by new codes 37252 and 37253.
Mediastinoscopy code 39400 has been deleted and converted into two codes (39401, 39402) to reflect the
current use of these procedures, including lymph node biopsy for cancer staging. In the Digestive System
subsection, multiple Category I and Category III codes have been either added or deleted, including the
addition of 14 new codes (47531-47544) and the addition of extensive guidelines and numerous parenthetical
notes pertaining to transhepatic and transcholecystic biliary procedures. In addition, a new table has been
added to direct users to the appropriate use of these new codes in association with catheters and stent
procedures.
A large number of changes have been made to the Urinary System subsection, including some revisions that
are editorial in nature pertaining to anatomy and the assignment of primary and secondary procedures. Other
revisions include the deletion of codes 50392, 50393, 50394, and 50398, and the addition of new codes
(50430, 50431, 50432, 50433, 50434, 50435), headings, and guidelines for reporting genitourinary catheter
procedures and associated nephrostogram, nephrostomy, and nephroureteral services. Some of the new
codes added describe biopsy and dilation of the ureter, nonendoscopic endoluminal biopsy of the ureter and/or
renal pelvis, and the percutaneous placement of ureteral stent and embolization and balloon dilation of the
ureter using nonendoscopic imaging guidance. In addition, the Male Genital System subsection contains two
new codes (54437, 54438) to report traumatic penile injury repairs.
New codes and numerous instructional parenthetical notes pertaining to three new codes (61645, 61650,
61651) describing cerebral endovascular therapeutic interventions in intracranial arteries have been added in
the Nervous System subsection. Rarely performed procedure code 64412 was deleted. Three codes (64461,
64462, 64463) to identify thoracic paravertebral blocks and continuous infusions have also been added, and
changes have been made to the guidelines pertaining to the 64633-64636 series of codes.
INTEGUMENTARY SYSTEM4
New
Codes
Description
10035
Placement of soft tissue localization device(s) (e.g., clip, metallic pellet, wire/needle,
radioactive seeds), percutaneous, including imaging guidance; first lesion
10036
each additional lesion (List separately in addition to code for primary procedure)
Two new codes (10035, 10036) have been established in the Skin, Subcutaneous, and Accessory Structures
subsection to report initial and additional lesion placement of soft tissue localization device(s). Introductory
guidelines and instructional parenthetical notes were added to clarify the reporting for the placement of soft
tissue location device(s).
With advances in clinical practice and chemotherapy, it is becoming increasingly important to mark lesions
prior to therapy. Often a lesion will no longer be visible or palpable after therapy, and marking a lesion prior to
therapy allows the area to be found for subsequent resection after therapy has been completed. While codes
exist for marker placements into various organs, there is no code for soft tissue marker placement such as in
the axilla or groin, and placement of markers into the soft tissues is becoming increasingly more important.
As a result, codes 10035 and 10036 have been established to capture marker placements into areas such as
the axilla and/or groin tissue. Insertion of soft tissue markers is typically performed with imaging guidance
including ultrasound, fluoroscopy, computed tomography, or magnetic resonance imaging, and the guidance
4
Ibid at Page 71.
5
is considered a bundled service. Therefore, imaging codes (76942, 77002, 77012, and 77021) should not be
reported separately. Marker placement codes 10035 and 10036 should only be reported once per target,
regardless of how many markers are used to mark the target. It would be appropriate to report code 10036 for
a second procedure on the same side or contralateral side.
If a more specific site descriptor is applicable (e.g., breast), use the site-specific codes for marker placement
at that site. For example, report code 32553 for the percutaneous placement of an interstitial device(s) for an
intrathoracic site; report code 49411 for the percutaneous placement of an interstitial device(s) for an intraabdominal, an intra-pelvic (except prostate), and/or a retroperitoneum site; report code 55876 for the
placement of an interstitial device(s) for the prostate; report codes 19081-19086 for the placement of a
localization device for breast biopsy; and report codes 19281-19287 for the percutaneous placement of a
localization device(s) for the breast.
MUSCULOSKELETAL
NECK (SOFT T ISSUES) AND THORAX
5
FRACTURE AND/OR DISLOCATION
Deleted
Description
Codes
Open treatment of rib fracture without fixation, each
21805
INTRODUCTION OR REMOVAL
Revised
Codes
20555
6
Description
Placement of needles or catheters into muscle and/or soft tissue for subsequent interstitial
radioelement application (at the time of or subsequent to the procedure)
In accordance with the deletion of codes 77776, 77777, 77785, 77786, and 77787, the parenthetical note
following code 20555 has been revised with the removal of these codes and replaced with codes 77770,
77771 and 77772.
RESPIRATORY
7
TRACHEA AND BRONCHI
New
Description
Codes
31652
with endobronchial ultrasound (EBUS) guided transtracheal and/or transbronchial sampling
(e.g., aspiration[s]/biopsy[ies]), one or two mediastinal and/or hilar lymph node stations or
structures
31653
with endobronchial ultrasound (EBUS) guided transtracheal and/or transbronchial sampling
(e.g., aspiration[s]/biopsy[ies]), 3 or more mediastinal and/or hilar lymph node stations or
structures
31654
with transendoscopic endobronchial ultrasound (EBUS) during bronchoscopic diagnostic or
therapeutic intervention(s) for peripheral lesion(s) (List separately in addition to code for
primary procedure[s])
Three new codes (31652, 31653, 31654), a new set of guidelines, and parenthetical notes have been
established in the Trachea and Bronchi subsection to more appropriately identify transendoscopic Ibid at
5
6
7
Ibid at Page 117
Ibid at Page 106
Ibid at Page 181.
6
endobronchial ultrasound (EBUS) procedures. As a result of the establishment of these new codes,
guidelines, and parenthetical notes, code 31620 has been deleted.
These changes were initiated as a result of a survey requested by the AMA/Specialty Society Relative Value
Scale (RVS) Update Committee (RUC) and Relativity Assessment Workgroup (RAW). RAW identified overlap
between the use of code 31620 (used as an add-on procedure in conjunction with bronchoscopy to identify
ultrasound for diagnostic and therapeutic interventions) and code 31629. Because code 31620 may be
reported with bronchoscopic biopsy procedures, clarification was needed regarding when the add-on
ultrasound procedure may be reported. It was concluded that the services had evolved and should be
represented with codes that accurately portrayed the combi nation of procedures that are commonly
performed together.
As a result, codes 31652 and 31653 have been developed to identify two bronchoscopic procedures that are
commonly performed together: transtracheal and/or transbronchial sampling procedures (e.g., aspirations or
biopsy procedures) performed using endobronchial ultrasound guidance for one or two lymph node stations
(31652) or for three or more stations or structures (31653). To correspond with this change, code 31620 has
been deleted to remove redundancy in reporting endobronchial ultrasound performed for the purpose of
biopsy. In addition, code 31654 has been established to identify transendoscopic endobronchial ultrasound
procedures performed during diagnostic or therapeutic bronchoscopic procedures for lesions peripheral to
the lymph node stations or structures.
Guidelines included within this section provide instruction to users regarding the intended use for codes
31652-31654. To provide further instruction for users, parenthetical notes have been established, removed,
or reassigned to coincide with the addition of the new codes and to direct users to codes for other
bronchoscopic, tracheoscopic, or laryngoscopic procedures that could be mistakenly reported with these
new codes. These parenthetical notes include codes or code ranges to direct users to the correct codes for
these procedures.
Code 31620 was previously used to report the add-on services of endobronchial ultrasound performed during
diagnostic or therapeutic services. Codes 31652-31654 are now intended to be reported according to the
actual service provided. The difference is that the services have been “bundled” to more accurately represent
how these services are currently performed. In addition, parenthetical notes have been provided to direct
users to codes in which add-on code 31654 may be additionally reported. Descriptor language within these
codes specifically identifies that these codes are intended to be used once, regardless of the number of
aspiration or biopsy procedures that are needed to accomplish the service (whether sampling for one or two
node stations or sampling for three or more stations or structures). The number of times each of these codes
may be reported is also specified within the parenthetical note that follows code 31654 (noting that codes
31652-31654 may only be reported once per session).
In accordance with the deletion of codes 77785, 77786, and 77787, the parenthetical note following code
31643 has been revised with the removal of these codes and replaced with codes 77770, 77771, and 77772.
Refer to the codebook and the Rationale for codes 77770, 77771, and 77772 for a full discussion of the
changes.
Deleted
Codes
31620
Description
Endobronchial ultrasound (EBUS) during bronchoscopic diagnostic or therapeutic
intervention(s) (List separately in addition to code for primary procedure[s])
Code 31620 has been deleted. For bronchoscopy with endobronchial ultrasound [EBUS] guided transtracheal/
transbronchial sampling of mediastinal and/or hilar lymph node stations or structures, see 31652, 31653. For
transendoscopic ultrasound during bronchoscopic diagnostic or therapeutic intervention[s] for peripheral
lesion[s], use 31654.
7
Revised
Codes
31632
31633
Description
with transbronchial lung biopsy(s), each additional lobe (List separately in addition to code
for primary procedure)
with transbronchial needle aspiration biopsy(s), each additional lobe (List separately in
addition to code for primary procedure)
Codes 31632 and 31633 have been revised to include moderate sedation.
CARDIOVASCULAR
8
CARDIAC VALVES
New
Description
Codes
33477
Transcatheter pulmonary valve implantation, percutaneous approach, including prestenting of the valve delivery site, when performed
Code 33477 is used to report Transcatheter pulmonary valve implantation (TPVI). Code 33477 should only be
reported once per session.
Code 33477 includes the work, when performed, of percutaneous access, placing the access sheath,
advancing the repair device delivery system into position, repositioning the device as needed, and deploying
the device(s). Angiography, radiological supervision, and interpretation performed to guide TPVI (e.g., guiding
device placement and documenting completion of the intervention) are included in the code.
Code 33477 includes all cardiac catheterization(s), intraprocedural contrast injection(s), fluoroscopic
radiological supervision and interpretation, and imaging guidance performed to complete the pulmonary valve
procedure. Do not report 33477 in conjunction with 76000, 76001, 93451, 93453, 93454, 93455,
93456, 93457, 93458, 93459, 93460, 93461, 93530, 93531, 93532, 93533, 93563, 93566, 93567, 93568 for
angiography intrinsic to the procedure.
Code 33477 includes percutaneous balloon angioplasty of the conduit/treatment zone, valvuloplasty of the
pulmonary valve conduit, and stent deployment within the pulmonary conduit or an existing bioprosthetic
pulmonary valve, when performed. Do not report 33477 in conjunction with 37236, 37237,
92997, 92998 for pulmonary artery angioplasty/valvuloplasty or stenting within the prosthetic valve delivery
site.
Codes 92997, 92998 may be reported separately when pulmonary artery angioplasty is performed at a site
separate from the prosthetic valve delivery site. Codes 37236, 37237 may be reported separately when
pulmonary artery stenting is performed at a site separate from the prosthetic valve delivery site.
Diagnostic right heart catheterization and diagnostic coronary angiography codes (93451, 93453, 93454,
93455, 93456, 93457, 93458, 93459, 93460, 93461, 93530, 93531, 93532, 93533, 93563, 93566, 93567,
93568) should not be used with 33477 to report:
1. Contrast injections, angiography, roadmapping, and/or fluoroscopic guidance for the TPVI,
2. Pulmonary conduit angiography for guidance of TPVI, or
3. Right heart catheterization for hemodynamic measurements before, during, and after TPVI for
guidance of TPVI.
Diagnostic right and left heart catheterization codes (93451, 93452, 93453, 93456, 93457, 93458, 93459,
8
Ibid at Page 205.
8
93460, 93461, 93530, 93531, 93532, 93533), diagnostic coronary angiography codes (93454, 93455,
93456, 93457, 93458, 93459, 93460, 93461, 93563, 93564), and diagnostic pulmonary angiography code
(93568) may be reported with 33477, representing separate and distinct services from TPVI, if:
.
1. No prior study is available and a full diagnostic study is performed, or
2. A prior study is available, but as documented in the medical record:
4. There is inadequate visualization of the anatomy and/or pathology, or
5. The patient’s condition with respect to the clinical indication has changed since the prior study, or
6. There is a clinical change during the procedure that requires new evaluation.
Other cardiac catheterization services may be reported separately when performed for diagnostic purposes not
intrinsic to TPVI.
For same session/same day diagnostic cardiac catheterization services, report the appropriate diagnostic
cardiac catheterization code(s) appended with modifier 59 to indicate separate and distinct procedural services
from TPVI.
Diagnostic coronary angiography performed at a separate session from an interventional procedure may be
separately reportable, when performed.
Percutaneous coronary interventional procedures may be reported separately, when performed. Percutaneous
pulmonary artery branch interventions may be reported separately, when performed.
When Transcatheter ventricular support is required in conjunction with TPVI, the appropriate code may be
reported with the appropriate percutaneous ventricular assist device (VAD) procedure codes (33990, 33991,
33992, 33993), extracorporeal membrane oxygenation (ECMO) or extracorporeal life support services (ECLS)
procedure codes (33946-33989), or balloon pump insertion codes (33967, 33970, 33973).
When cardiopulmonary bypass is performed in conjunction with TPVI, code 33477 may be reported with the
appropriate add-on code for percutaneous peripheral bypass (33367), open peripheral bypass (33368), or
central bypass (33369).
9
ARTERIAL MECHANICAL THROMBECTOMY
Revised
Description
Codes
37184
Primary percutaneous transluminal mechanical thrombectomy, noncoronary, non-intracranial,
arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural
pharmacological thrombolytic injection(s); initial vessel
37185
second and all subsequent vessel(s) within the same vascular family (List separately in addition to
code for primary mechanical thrombectomy procedure)
37186
Secondary percutaneous transluminal thrombectomy (e.g., nonprimary mechanical, snare basket,
suction technique), noncoronary, non-intracranial, arterial or arterial bypass graft, including
fluoroscopic guidance and intraprocedural pharmacological thrombolytic injections, provided in
conjunction with another percutaneous intervention other than primary mechanical thrombectomy
(List separately in addition to code for primary procedure)
In support of the establishment of code 61645, codes 37184, 37185, and 37186 have been revised to include
non-intracranial, and exclusionary parenthetical notes have been added and revised to clarify the reporting of
this service.
9
Ibid at Page 245.
9
Deleted
Codes
37202
Description
Transcatheter therapy, infusion other than for thrombolysis, any type (e.g., spasmolytic,
vasoconstrictive)
Code 37202 has also been deleted and a deletion parenthetical note directs users to codes 61650 and 61651
to ensure appropriate reporting of these services.
10
VENA CAVA FILTER
Revised
Description
Codes
37211
Transcatheter therapy, arterial infusion for thrombolysis other than coronary, intracranial,
any method, including radiological supervision and interpretation, initial treatment day
11
INTRAVACULAR ULTRASOUND SERVICES
Deleted
Description
Codes
37250
Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or
therapeutic intervention; initial vessel (List separately in addition to code for primary
procedure)
37251
each additional vessel (List separately in addition to code for primary procedure)
New
Codes
37252
37253
Description
Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or
therapeutic intervention, including radiological supervision and interpretation; initial
noncoronary vessel (List separately in addition to code for primary procedure)
each additional noncoronary vessel (List separately in addition to code for primary
procedure)
Four codes, 37250 and 37251 (intravascular ultrasound [IVUS] for non-coronary vessels) and 75945 and
75946 (radiological supervision and interpretation), have been deleted, and two new codes (37252,
37253) that bundle these services, which were previously described by the four deleted codes, have been
established in the IVUS Services subsection. As a result of the establishment of these new codes, guidelines
have been revised and parenthetical notes added to instruct users on the appropriate use of these codes.
The changes in these codes are a continuation of the bundling efforts to enable more efficient reporting of
intravascular ultrasound during venous and arterial contrast angiography and endovascular intervention,
especially for services that are usually reported together. Because codes 37250 and 37251 are typically
reported together with codes 75945 and 75946 (radiological supervision and interpretation), the services
described by these codes are now reported with the newly established codes 37252 and 37253.
As codes 37252 and 37253 are add-on codes, they should never be reported as stand-alone codes. Instead,
they should be reported in addition to therapeutic intervention (e.g., stent or stent graft placement, angioplasty,
atherectomy, embolization, thrombolysis, Transcatheter biopsy), during which the IVUS is performed.
10
11
Ibid at Page 247.
Ibid at Page 253.
10
As clarified in the guidelines, if a lesion extends across the margins of one vessel into another, this should be
reported with a single code despite imaging more than one vessel. For example, if a lesion bridges in to two or
more vessels, it would still be counted as one vessel and, therefore, reported with code 37252. In contrast, if
there are two separate vessels and each has a lesion that is not continuous, add-on code
37253 should be additionally reported.
MEDIASTINUM AND DIAGPHRAGM 12
MEDIASTINUM
Deleted
Codes
39400
Description
Mediastinoscopy, includes biopsy(ies), when performed
39400 has been deleted. To report mediastinoscopy with biopsy, see 39401, 39402)
New
Codes
39401
39402
Description
Mediastinoscopy; includes biopsy(ies) of mediastinal mass (e.g., lymphoma), when
performed
with lymph node biopsy(ies) (e.g., lung cancer staging)
Two new codes (39401, 39402) have been established to report mediastinoscopy and biopsies of the
mediastinum and lymph node(s), and code 39400 has been deleted in the Mediastinum subsection.
The revisions to the mediastinoscopy codes have been made to reflect changes in clinical practice toward the
performance of less invasive procedures rather than mediastinoscopy procedures.
Revisions to the codes used to report mediastinoscopy procedures were first initiated as a result of a request
from RAW. RAW identified code 39400 as a potentially misvalued code and upon review, it was determined
that the performance of mediastinoscopy had steadily decreased every year since 2006. The decrease was
attributed to the development and refinement of noninvasive lung cancer staging modalities, such as computed
tomography (CT) and positron emission tomography (PET). In addition, pathologic staging of lung cancer can
now be accomplished using the less invasive technique of EBUS-guided biopsy.
Currently, mediastinoscopy is most commonly performed for staging of lung cancer and utilized when CT and
PET procedures are inconclusive. It may also be performed in patients who are determined to be at high risk
for lung surgery (e.g., those with severe chronic obstructive pulmonary disease [COPD]). While the proper
staging of lung cancer (which may involve the systematic biopsying of designated lymph node stations) can be
critical to determine appropriate treatment, mediastinoscopy can also be utilized to establish a diagnosis in
patients with a large mediastinal mass. As a result, the type of patient for whom the mediastinoscopy
procedure is performed on has changed. Moreover, the site of service has shifted from hospital inpatient to
hospital outpatient, and less than 1% of these procedures are performed in ambulatory surgery centers.
Consequently, codes 39401 and 39402 have been established to identify the current uses for these
procedures, as lymph node sampling for pathologic staging is more involved than a mediastinoscopy
performed for a biopsy of a mediastinal mass.
All of these changes inherently require the deletion of code 39400 as this code does not allow for distinction
between the services as they are currently provided. Code 39400 was originally intended to identify
mediastinoscopy performed for the purpose of diagnosing lung cancer. This included the procurement of one
or more biopsy samples from a single mediastinal mass without attention to the margins.
12
Ibid at Page 260.
11
DIGESTIVE 13
ESOPHAGOSCOPY
New
Codes
43210
Description
with esophagogastric fundoplasty, partial or complete, includes duodenoscopy when
performed
A new code (43210) has been established in the Esophagogastroduodenoscopy subsection to describe a
transoral approach to a surgical esophagogastric fundoplasty procedure. An exclusionary parenthetical note
has also been added and several others revised to restrict the use of this code with codes 43180, 43191,
43197, 43200, and 43235.
Fundoplication may be performed for patients with chronic gastroesophageal reflux disease (GERD) who
cannot be managed with conventional pharmacologic and medical management. Code 43210 is for a partial or
complete esophagogastric fundoplasty and includes duodenoscopy when performed. The procedure of
esophagogastric fundoplasty performed through a transoral approach is different than a fundoplasty performed
through a laparotomy, thoracotomy, or laparoscopy approach. Because of the difference in the described
procedures, there was previously no mechanism of reporting this service.
Deleted
Codes
47136
Description
heterotopic, partial or whole, from cadaver or living donor, any age
Code 47136 has been deleted and a deletion parenthetical note has been added in the Liver Transplantation
subsection.
Code 47136 was used to report heterotopic liver allotransplantation, which involved leaving the recipient organ
in place while transplanting a donor liver in a different (ectopic) location. When introduced, this procedure was
believed to be useful for reversible liver disease in which the transplanted liver was removed once the native
liver recovered. However, this procedure was rarely performed in the United States. Therefore, as part of an
effort to ensure that the CPT code set reflects current clinical practice, code 47136 has been deleted due to
low utilization, and a deletion parenthetical note directing users to unlisted code 47399 has been added.
Deleted
Codes
47136
Description
heterotopic, partial or whole, from cadaver or living donor, any age
Code 47136 has been deleted and a deletion parenthetical note has been added in the Liver Transplantation
subsection.
Code 47136 was used to report heterotopic liver allotransplantation, which involved leaving the recipient organ
in place while transplanting a donor liver in a different (ectopic) location. When introduced, this procedure was
believed to be useful for reversible liver disease in which the transplanted liver was removed once the native
liver recovered. However, this procedure was rarely performed in the United States. Therefore, as part of an
effort to ensure that the CPT code set reflects current clinical practice, code 47136 has been deleted due to
low utilization, and a deletion parenthetical note directing users to unlisted code 47399 has been added.
13
Ibid at Page 272.
12
Deleted
Codes
47500
47505
Description
Injection procedure for percutaneous transhepatic cholangiography
47510
Injection procedure for cholangiography through an existing catheter (e.g., percutaneous
transhepatic or T-tube)
Introduction of percutaneous transhepatic catheter for biliary drainage
47511
Introduction of percutaneous transhepatic stent for internal and external biliary drainage
47525
Change of percutaneous biliary drainage catheter
47530
Revision and/or reinsertion of transhepatic tube
47500, 47505, 47510, 47511, 47525, 47530 have been deleted. To report, see 47531-47541.
Codes 47500, 47505 (cholangiography injection); 47510, 47511 (transhepatic catheter for biliary drainage);
47525 (change of biliary drainage catheter); 47530 (revision and/or reinsertion of transhepatic tube); and
74305, 74320, 75980, 75982 (radiological supervision and interpretation) have been deleted, and in their stead,
14 new codes (47531-47544) to bundle these services have been established in the Biliary Tract subsection. As
a result of the establishment of these codes, a new table, illustration, guidelines, and numerous parenthetical
notes have been added to instruct users on the appropriate use of these codes.
These changes were made in response to RAW’s analysis to combine codes that are frequently reported
together.
14
BILLIARY TRACT
New
Description
Codes
47531
Injection procedure for cholangiography, percutaneous, complete diagnostic procedure
including imaging guidance (e.g., ultrasound and/or fluoroscopy) and all associated
radiological supervision and interpretation; existing access
47532
new access (e.g., percutaneous transhepatic cholangiogram)
47533
47534
47535
47536
47537
14
Placement of biliary drainage catheter, percutaneous, including diagnostic cholangiography
when performed, imaging guidance (e.g., ultrasound and/or fluoroscopy), and all
associated radiological supervision and interpretation; external
internal-external
Conversion of external biliary drainage catheter to internal-external biliary drainage
catheter, percutaneous, including diagnostic cholangiography when performed, imaging
guidance (e.g., fluoroscopy), and all associated radiological supervision and interpretation
Exchange of biliary drainage catheter (e.g., external, internal-external, or conversion of
internal-external to external only), percutaneous, including diagnostic cholangiography
when performed, imaging guidance (e.g., fluoroscopy), and all associated radiological
supervision and interpretation
Removal of biliary drainage catheter, percutaneous, requiring fluoroscopic guidance (e.g.,
with concurrent indwelling biliary stents), including diagnostic cholangiography when
performed, imaging guidance (e.g., fluoroscopy), and all associated radiological
supervision and interpretation
Ibid at Page 305.
13
47538
Placement of stent(s) into a bile duct, percutaneous, including diagnostic cholangiography,
imaging guidance (e.g., fluoroscopy and/or ultrasound), balloon dilation, catheter
exchange(s) and catheter removal(s) when performed, and all associated radiological
supervision and interpretation, each stent; existing access
47539
new access, without placement of separate biliary drainage catheter
47540
new access, with placement of separate biliary drainage catheter (e.g., external or internalexternal
Placement of access through the biliary tree and into small bowel to assist with an
endoscopic biliary procedure (e.g., rendezvous procedure), percutaneous, including
diagnostic cholangiography when performed, imaging guidance (e.g., ultrasound and/or
fluoroscopy), and all associated radiological supervision and interpretation, new access
Balloon dilation of biliary duct(s) or of ampulla (sphincteroplasty), percutaneous, including
imaging guidance (e.g., fluoroscopy), and all associated radiological supervision and
interpretation, each duct (List separately in addition to code for primary procedure)
Endoluminal biopsy(ies) of biliary tree, percutaneous, any method(s) (e.g., brush, forceps,
and/or needle), including imaging guidance (e.g., fluoroscopy), and all associated
radiological supervision and interpretation, single or multiple (List separately in addition to
code for primary procedure)
Removal of calculi/debris from biliary duct(s) and/or gallbladder, percutaneous, including
destruction of calculi by any method (e.g., mechanical, electrohydraulic, lithotripsy) when
performed, imaging guidance (e.g., fluoroscopy), and all associated radiological
supervision and interpretation (List separately in addition to code for primary procedure)
47541
47542
47543
47544
New percutaneous biliary procedure codes 47531-47544 include imaging guidance and diagnostic
cholangiography. Codes 47531 and 47532 describe a complete diagnostic cholangiography procedure
including imaging guidance, and are reported based on existing access (47531) or new access (47532).
Codes 47533-47540 describe percutaneous therapeutic biliary procedures, code 47541 is a procedure to
assist with access though the biliary tree and into the small bowel for other endoscopic procedures. Codes
47542-47544 are add-on codes describing various procedures that may be performed in conjunction with other
codes in this family. A new table has been added to help determine the appropriate code(s) for reporting
exchanges and/or conversions of biliary drainage using either internal -external or external catheters or
placement of stents. To further clarify the intent for use of these codes, guidelines were added to clarify the
differences between internal-external, external catheters, and stents.
Deleted
Codes
47560
47561
47630
Description
Laparoscopy, surgical; with guided transhepatic cholangiography, without biopsy
with guided transhepatic cholangiography with biopsy
Biliary duct stone extraction, percutaneous via T-tube tract, basket, or snare (e.g.,
Burhenne technique)
Two codes (47560, 47561) have been deleted and code 47562 has been restructured in the Biliary Tract
Laparoscopy subsection. In addition, new instructional parenthetical notes have been added to provide
instruction on the proper reporting of these services.
Code 47560 described a laparoscopy with transhepatic cholangiography performed without a biopsy. Code
47561 described the procedure performed with a biopsy. Laparoscopic cholangiography is no longer standard
practice, as more advanced imaging techniques have been developed (e.g., magnetic imaging and computed
tomography); therefore, these codes have been deleted, and unlisted code 47579 should now be reported for
laparoscopically guided transhepatic cholangiography.
14
In accordance with the deletion of code 47630, a deletion parenthetical note has been added in the Biliary
Tract Excision subsection.
15
ABDOMEN, PERITONEUM, AND OMENTUM
New
Description
Codes
49185
Sclerotherapy of a fluid collection (e.g., lymphocele, cyst, or seroma), percutaneous,
including contrast injection(s), sclerosant injection(s), diagnostic study, imaging guidance
(e.g., ultrasound, fluoroscopy) and radiological supervision and interpretation when
performed
A new code (49185) has been established in the Abdomen, Peritoneum, and Omentum Excision, Destruction
subsection to identify percutaneous sclerotherapy of a fluid collection, such as a seroma or lymphocele. To
support the addition of the new code, guidelines and parenthetical notes have also been added.
Code 49185 has been added to allow specific reporting of the drainage of certain types of fluid collection.
Because there are other types of fluid collections that are not listed in the parenthetical within the code
descriptor, parenthetical notes have been added following the code to direct users to the appropriate codes to
use to report drainage of other types of fluid collections. This includes appropriate reporting for vascular
malformations or lymphatic collections (37241), sclerosis performed for veins or ablation procedures for
incompetent extremity veins (e.g., 36468, 36470), and pleurodesis (32560). In addition, other methods of
performing drainages are also noted within the parentheticals, such as access or drainage procedures with a
needle (10160, 50390), or other types of drainage or exchange procedures. The parentheticals also provide
instruction regarding how to report multiple, distinct drainage procedures that require separate access versus
multiple fluid collections that may be drained using the same access.
Guidelines have been added to instruct users on the appropriate reporting of this code. The guidelines clarify
that diagnostic study of the collection, image guidance, sclerosant injection (or multiple injections, if needed),
and any radiological supervision or interpretation needed to accomplish the procedure are included in code
49185.
This procedure does not include the drainage of the fluid prior to sclerotherapy treatment. Drainage represents
separate work and should be reported with the drainage procedure code for that anatomical site with modifier
51 appended to identify the secondary procedure performed. For example, placement of a drainage catheter
left in place for use for injection of sclerosant over several sessions may be reported with a code to identify the
drainage performed according to the anatomical site, and with code 49185 to identify the separately identifiable
sclerotherapy procedure. Complicated collections that require sclerotherapy and a procedure that inherently
includes drainage should be reported using the sclerotherapy code and the code for the procedure that was
performed to correct the fluid flow. For example, continuous high output of fluid for a collection may make it
clear that the collection will not stop draining without further treatment.
URINARY SYSTEM
INTRODUCTION 16
Revised
Codes
50387
15
16
Description
Removal and replacement of externally accessible transnephric ureteral tent
nephroureteral catheter (e.g., external/internal stent) requiring fluoroscopic guidance,
including radiological supervision and interpretation
Ibid at Page 310.
Ibid at Page 321
15
Code 50387 has been revised to match changes made to the Other Introduction (Injection/Change/Removal)
Procedures guidelines.
The phrase “transnephric ureteral stent” has been replaced with the phrase “nephroureteral catheter,” as the
new phrase better describes the service, anatomy involved in the service, and the type of device used.
Deleted
Codes
50392
50393
50394
50398
Description
Introduction of intracatheter or catheter into renal pelvis for drainage and/or injection,
percutaneous
Introduction of ureteral catheter or stent into ureter through renal pelvis for drainage and/or
injection, percutaneous
Injection procedure for pyelography (as nephrostogram, pyelostogram, antegrade
pyeloureterograms) through nephrostomy or pyelostomy tube, or indwelling ureteral
catheter
Change of nephrostomy or pyelostomy tube
OTHER INTRODUCTION (INJECTION/CHANGE/REMOVAL) PROCEDURES
New
Description
Codes
50430
50431
50432
50433
50434
50435
17
Injection procedure for antegrade nephrostogram and/or ureterogram, complete diagnostic
procedure including imaging guidance (e.g., ultrasound and fluoroscopy) and all associated
radiological supervision and interpretation; new access
existing access
Placement of nephrostomy catheter, percutaneous, including diagnostic nephrostogram
and/or ureterogram when performed, imaging guidance (e.g., ultrasound and/or
fluoroscopy) and all associated radiological supervision and interpretation
Placement of nephroureteral catheter, percutaneous, including diagnostic nephrostogram
and/or ureterogram when performed, imaging guidance (e.g., ultrasound and/or
fluoroscopy) and all associated radiological supervision and interpretation, new access
Convert nephrostomy catheter to nephroureteral catheter, percutaneous, including
diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (e.g.,
ultrasound and/or fluoroscopy) and all associated radiological supervision and
interpretation, via pre-existing nephrostomy tract
Exchange nephrostomy catheter, percutaneous, including diagnostic nephrostogram and/or
ureterogram when performed, imaging guidance (e.g., ultrasound and/or fluoroscopy) and
all associated radiological supervision and interpretation
Six new codes (50430, 50431, 50432, 50433, 50434, 50435) have been established and four codes (50392,
50393, 50394, 50398) have been deleted under the heading Other Introduction (Injection/Change/Removal)
Procedures in the Kidney subsection. Exclusionary parenthetical notes regarding the intended use of these
codes, as well as an instructional parenthetical note following code 50435 directing users to the appropriate code
to report the removal of a nephrostomy catheter requiring fluoroscopic guidance, were also added.
Codes 50430 and 50431 are injection procedures for antegrade nephrostogram/ureterogram using a new access
(50430) or an existing access (50431) to the injection site. The procedures include complete diagnostic services
(which includes imaging).
17
Ibid at Page 322-323
16
Because many of the codes within the Genitourinary services subsection have been constructed to reflect only
those procedures that are commonly performed together, diagnostic services have been inherently included as
part of many of the services and procedures that are listed. However, separate codes have been established for
injections for diagnostic antegrade nephrostogram/ureterogram to allow independent reporting of diagnostic
services when these services are not inherently included as part of the procedure. Services that include the
diagnostic procedure include a description of this service within the descriptor (as well as guidelines and/or
parenthetical notes). For those services that do not inherently include diagnostic services (e.g., biopsy,
embolization, or dilation of the ureter [50606, 50705, 50706]), codes 50430 and 50431 may be separately
reported. This is exemplified within the exclusionary parenthetical note that follows code 50431 as this
parenthetical lists all of codes that may not be separately reported in conjunction with code 50431.
Codes 50432, 50433, 50434, and 50435 identify the percutaneous placement of a nephrostomy catheter
(50432), the percutaneous placement of a nephroureteral catheter (50433), the conversion of a nephrostomy
catheter to a nephroureteral catheter (50434), and the exchange of a nephrostomy catheter (50435).
URETER
18
INCISION/BIOPSY
New
Description
Codes
50606
Endoluminal biopsy of ureter and/or renal pelvis, non-endoscopic, including imaging
guidance (e.g., ultrasound and/or fluoroscopy) and all associated radiological supervision
and interpretation (List separately in addition to code for primary procedure)
The heading for the Incision subsection has been revised. The term “/Biopsy” has been added to the heading
to acknowledge code 50606 within this section. Addition of this term facilitates identification of this section for
codes to use for reporting biopsy procedures of the ureter.
Code 50606, which is used to identify non-endoscopic endoluminal biopsy of the ureter and/or renal pelvis, is
ordinarily performed with other genitourinary procedures. As a result, it has been designated as an add-on
code. Refer to the codebook and see the Rationale for codes 50705 and 50706 for a full discussion of the
changes.
The exclusionary parenthetical note that follows code 50606 is intended to identify all services that should not
be separately reported for the endoluminal biopsy of the ureter or renal pelvis when those procedures are
performed for the same renal collecting system and/or associated ureter. If these services are performed on a
different collecting system and/or ureter, then these services may be separately reported. In these instances,
modifier 59 should be appended to identify that the service is distinct from the biopsy.
INTRODUCTION
New
Codes
50693
18
19
19
Description
50694
Placement of ureteral stent, percutaneous, including diagnostic nephrostogram and/or
ureterogram when performed, imaging guidance (e.g., ultrasound and/or fluoroscopy), and
all associated radiological supervision and interpretation; pre-existing nephrostomy tract
new access, without separate nephrostomy catheter
50695
new access, with separate nephrostomy catheter
Ibid at Page 326.
Ibid at Page 327.
17
A new heading titled “Other Introduction/Injection/Change/Removal Procedures” has been added to the
Ureter/Introduction subsection to allow the placement of three new codes used to identify ureteral stent
placement procedures into this subsection. New guidelines have also been added.
The guidelines provide instruction to users regarding the services that are inherently included as part of the
stent placement procedures as well as clarify the appropriate codes to report when a separate ureteral stent
procedure is performed through a new percutaneous renal access during the same session.
The percutaneous stent-placement procedure codes (50693, 50694, 50695) include the diagnostic
nephrostogram/ureterogram, when performed, as well as imaging (e.g., ultrasound or fluoroscopy) and
radiological supervision and interpretation as noted in the code descriptor. As is true for other
genitourinary services, exclusionary parenthetical notes have been added following code 50695 to restrict
reporting other genitourinary services performed on the same collecting system or ureter.
20
REPAIR
New
Codes
50705
50706
Description
Ureteral embolization or occlusion, including imaging guidance (e.g., ultrasound and/or
fluoroscopy) and all associated radiological supervision and interpretation (List separately
in addition to code for primary procedure)
Balloon dilation, ureteral stricture, including imaging guidance (e.g., ultrasound and/or
fluoroscopy) and all associated radiological supervision and interpretation (List separately
in addition to code for primary procedure)
Three new codes have been added to identify non-endoscopic endoluminal biopsy of the ureter and/or renal
pelvis (50606), embolization of the ureter (50705), and dilation of a stricture within the ureter (50706).
Separate codes were created for these services to allow granularity in reporting for provision of these services
from other urinary services that may be provided.
These codes have been designated as add-on codes as they only include the intervention or procedure noted
within the descriptor for that code. Because biopsy, embolization, and dilation of the ureter are ordinarily
performed with other procedures that require access and diagnostic procedures (such as catheter placement
procedures [50432, 50433]), the intent is that the services not specifically noted within the descriptor for codes
50606, 50705, and 50706 are intended to be captured in the reporting of other service codes, thereby
eliminating duplicate reporting of diagnostic, access, and other services.
As is noted with other genitourinary procedures, these services include language within their descriptors that
note that imaging to accomplish these services is inherently included as part of the service. As a result,
imaging to complete the biopsy, embolization, or dilation of the ureter is included as part of the service and not
separately reported.
URETER
21
INCISION/BIOPSY
New
Description
Codes
54437
Repair of traumatic corporeal tear(s)
54438
Replantation, penis, complete amputation including urethral repair
20
21
Ibid at Page 327.
Ibid at Page 343.
18
Two new codes (54437, 54438) have been established and an instructional parenthetical note has been added
to the Penis/Repair subsection.
Codes 54437 and 54438 are used to report traumatic penile repairs. These include penile fractures (i.e.,
corporeal tears of the penis) and complete amputation repairs. The addition of these codes includes the
addition of a parenthetical note that identifies appropriate reporting for incomplete amputation of the penis
(54437) and for repairs for the urethra (53410, 53415).
These codes were established because there were no specific CPT codes included to capture these types of
penile injury repairs. The only codes previously included in the CPT code set for penile repair r involved various
procedures for hypospadias (i.e., procedures completed to correct anatomically congenital “mislocation” of the
urethra [54300-54352]), chordee (downward angulation of the penis) and other angulation repairs (5436054390), various procedures for prosthetic implantation and/or removals (54400-54417), priapism (or erections
that do not return to a flaccid state within four hours [54420-54435]), or for any unspecific plastic surgery
operation for penis injury (54440). None of these codes specifically addressed reporting for penile fractures or
penile amputations.
Penile fracture occurs when the corpus cavernosum is compromised or “breaks” usually due to some type of
traumatic injury. The corpus cavernosum is the muscular outer portion of the penile shaft that inflates with
blood during an erection. When this anatomy fractures, the result is bruising and swelling of the penis at the
site of the fracture and severe pain. Repair involves the re-approximation of the severed ends, drainage of the
hematoma, and dissection of any damaged tissue to facilitate repair. Repairs for penile amputation are more
involved, as a complete amputation of the penis requires re-approximation of all severed components, which
includes musculature (at multiple levels), nerves, vasculature, and the urethra. Neither of these procedures is
adequately identified by the aforementioned series of codes. (Code 54440, Plastic operation of penis for injury,
represents a “catch-all” service for male plastic operations on the penis after injury. The variations and severity
of the injuries differ, and each repair is predicated on the type of injury. The services identified by the use of
code 54440 do not include mutilation injury repair or microsurgical vascular/nerve repair.)
As a result of the changes, code 54437 is now reported to identify repair of traumatic corporeal tears of the
penis. This includes the repair of incomplete penile amputations. Because rupture of the urethra (the tubule or
conduit within the penis that transfers urine from the bladder out of the body) is not always involved with the
fracture of the penis, repair of the urethra is separately reportable with codes 53410 or
53415, if performed. (A parenthetical note following codes 54437 and 54438 clarifies that repair of the urethra
is separately reportable.)
Complete penile replantation is identified by use of code 54438. This procedure includes repair of all severed
penile components including the musculature at all levels, all vascular repair, any nerve suture, and reapproximation of the urethra.
NERVOUS SYSTEM
22
ENDOVASCULAR THERAPY
New
Description
Codes
61645
Percutaneous arterial transluminal mechanical thrombectomy and/or infusion for
thrombolysis, intracranial, any method, including diagnostic angiography, fluoroscopic
guidance, catheter placement, and intraprocedural pharmacological thrombolytic
injection(s)
61650
Endovascular intracranial prolonged administration of pharmacologic agent(s) other than
for thrombolysis, arterial, including catheter placement, diagnostic angiography, and
22
Ibid at Page 375.
19
imaging guidance; initial vascular territory
61651
each additional vascular territory (List separately in addition to code for primary procedure)
Three new codes (61645, 61650, and 61651) have been established in the Endovascular Therapy subsection,
three codes (37184, 37185, and 37186) have been revised and new introductory language and parenthetical
notes have been added and revised.
In CPT 2013, four new codes (37211-37214) were established to report noncoronary transcatheter therapy for
thrombolysis. Code 37201 was deleted, and code 75896 was modified to prohibit its use for thrombolysis.
Although codes 37211-37214 specify noncoronary thrombolysis, the codes were developed primarily to
address peripheral thrombolysis. The neurovascular system is different from the peripheral vascular system
and central nervous system; therefore, these codes did not adequately reflect the complexity of the service of
either intracranial thrombolysis or mechanical thrombectomy. As a result, a new family of codes (61645-61651)
has been established to describe intracranial endovascular revascularization of occluded cerebral vessels and
intracranial prolonged infusion of agents that do not involve thrombolytic agents.
Code 61645 describes intracranial arterial mechanical thrombectomy and/or thrombolysis. Diagnostic
angiography, including radiologic supervision and interpretation, and procedural imaging guidance for the
treated territory has been bundled into this code.
Codes 61650 and 61651 describe the cerebral endovascular continuous or intermittent therapeutic prolonged
administration of any nonthrombolytic agent(s). Ipsilateral diagnostic angiography, including radiologic
supervision and interpretation and procedural imaging guidance for the treated territory, is bundled into these
codes.
EXTRACRANIAL NERVES, PERIPHERAL NERVES, AND AUTONOMIC NERVOUS SYSTEM
New
Description
Codes
64461
64462
64463
23
Paravertebral block (PVB) (paraspinous block), thoracic; single injection site (includes
imaging guidance, when performed)
second and any additional injection site(s) (includes imaging guidance, when performed)
(List separately in addition to code for primary procedure)
continuous infusion by catheter (includes imaging guidance, when performed)
Three new codes (64461, 64462, and 64463) have been established in the Introduction/Injection of Anesthetic
Agent (Nerve Block), Diagnostic or Therapeutic subsection to identify paravertebral blocks using single/
multiple injection(s) or continuous infusion using a catheter. Instructional and exclusionary parenthetical notes
have also been placed to assist users with appropriate reporting.
Paravertebral blocks (also known as paraspinous blocks) and continuous infusions can be used for the benefit
of pain management for patients undergoing thoracic, breast, and upper abdominal surgery. Because the
procedure may be performed at one or more levels or as a continuous infusion using a catheter in the thoracic
paravertebral region for postoperative analgesia, multiple codes have been established to allow appropriate
reporting. Codes 64461-64463 were established to reflect new procedures (i.e., thoracic paravertebral blocks
at single or multiple levels, and continuous infusion for the administration of local anesthetic for postoperative
pain control and thoracic and abdominal wall analgesia).
These procedures identify medication injection into the paravertebral area, as a single injection, as multiple
injections, or as a continuous infusion at any level of the thoracic spine. The intent is to provide a dense,
23
Ibid at Page 391.
20
ipsilateral somatic and sympathetic blockade as an analgesic alternative to a neuraxial blockade (which is
performed as an epidural or via access to the spine). Paravertebral blocks target the sympathetic chain of
nerves and multiple intercostal nerves and spinal nerves and their branches, and may be utilized for
dermatomal coverage from T2-L1. A single injection technique can allow restriction at multiple levels of spinal
nerves. Continuous catheter techniques can be used for targeting multiple dermatome levels and are intended
to increase the duration of the block.
Additional injections are identified by use of code 64462. This includes any number of additional injections
including laterally performed injections (i.e., code 64462 is intended to be reported only once regardless of the
number of additional injections or whether an additional injection is performed on the opposite side). This is
due to the fact that these injections are usually performed unilaterally according to the anatomical location that
is receiving the pain treatment (e.g., single breast). As a result of how the procedure is ordinarily performed,
additional injections are all included as part of a single additional report of add-on code 64462. An instructional
parenthetical note has been added to instruct users regarding this intent. An exclusionary parenthetical note
also lists other injection and imaging procedures that are excluded from additional reporting. Because image
guidance is specified within the descriptor for the service, imaging guidance is not separately reportable.
EYE AND OCULAR ADNEXA
ANTERIOR SEGMENTS
24
OTHER PROCEDURES
New
Description
Codes
65785
Implantation of intrastromal corneal ring segments
Category III code 0099T, which describes implantation of intrastromal corneal ring segments, has been deleted
and converted to Category I code 65785.
Code 0099T was scheduled to archive or “sunset” as a Category III code in January 2016. However, review of
the procedure showed it has received approval from the Food and Drug Administration, clinical efficacy has
been documented in literature, and all other criteria set forth for Category I status have been met. Therefore,
rather than archiving or retaining the procedure as a Category III code, it was determined as a Category I
service and relocated accordingly.
ANTERIOR CHAMBER
25
INCISION
Revised
Codes
65855
Description
Trabeculoplasty by laser surgery, 1 or more sessions (defined treatment series)
Code 65855 has been revised to omit the reference to “1 or more sessions (defined treatment series),” and an
exclusionary parenthetical note has been added to prevent the reporting of code 65855 in conjunction with
codes 65860, 65865, 65870, 65875, and 65880. The instructional parenthetical note regarding the use of a
modifier for re-treatment has been deleted.
During the 10-day global period, it is current practice to perform one initial application of laser treatment and
then monitor the results to determine whether it is necessary to perform additional treatments. To accurately
depict the current practice and reporting mechanics, the reference applied to code 65855 designating “1 or
more sessions” during a defined treatment series has been omitted.
24
25
Ibid at Page 405.
Ibid at Page 405
21
Codes 65860, 65865, 65870, 65875, and 65880 describe procedures that are encompassed in the
trabeculoplasty procedure described in code 65855, and thus an exclusionary parenthetical note has been
added to restrict the reporting of codes 65860, 65865, 65870, 65875, and 65880 in conjunction with code
65855.
Because code 65855 no longer describes multiple treatment sessions, it is not necessary to provide
instructions on how to report another series of sessions utilizing a modifier (e.g., 22, 52), which may be
required due to disease progression, as code 65855 is reported per treatment application and not as a
treatment series.
POSTERIOR SEGMENT
26
RETINA OR CHOROID
Revised
Description
Codes
67101
Repair of retinal detachment, 1 or more sessions; cryotherapy or diathermy, with or without
including drainage of subretinal fluid, when performed
67105
photocoagulation, with or without including drainage of subretinal fluid, when performed
67107
67108
67113
Deleted
Codes
67112
Repair of retinal detachment; scleral buckling (such as lamellar scleral dissection,
imbrication or encircling procedure), with or without including, when performed, implant,
with or without cryotherapy, photocoagulation, and drainage of subretinal fluid
with vitrectomy, any method, with or without including, when performed, air or gas
tamponed, focal end laser photocoagulation, cryotherapy, drainage of subretinal fluid,
scleral buckling, and/or removal of lens by same technique
Repair of complex retinal detachment (e.g., proliferative vitreoretinopathy, stage C-1 or
greater, diabetic traction retinal detachment, retinopathy of prematurity, retinal tear of
greater than 90 degrees), with vitrectomy and membrane peeling, including, may include
when performed, air, gas, or silicone oil tamponed, cryotherapy, endolaser
photocoagulation, drainage of subretinal fluid, scleral buckling, and/or removal of lens
Description
by scleral buckling or vitrectomy, on patient having previous ipsilateral retinal detachment
repair(s) using scleral buckling or vitrectomy techniques
Code 67112 has been deleted, and five codes (67101, 67105, 67107, 67108, and 67113) have been revised in
the Posterior Segment subsection to maintain consistency throughout the CPT code set.
Code 67112, used to report retinal detachment repair by scleral buckling, has been deleted, and a
Cross-reference parenthetical note has been added to direct users to the appropriate codes to report this
service. Code 67112 was infrequently reported and was ill-defined, as it combined a procedure (scleral
buckling) that is not used in this setting along with an unspecified vitrectomy that could be more accurately
described by reporting more specific codes (e.g., 67107, 67108, 67110, 67113). In addition, the parenthetical
note following code 66990 has been revised to omit code 67112.
Codes 67101, 67105, 67107, 67108, and 67113 have been revised to replace the phrase “with or without”
with “including . . . when performed” to follow CPT conventions for consistent terminology.
26
Ibid at Page 409.
22
27
DESTRUCTION
Revised
Description
Codes
67227
Destruction of extensive or progressive retinopathy (e.g., diabetic retinopathy), 1 or more
sessions, cryotherapy, diathermy
67228
Treatment of extensive or progressive retinopathy (e.g., 1 or more sessions diabetic
retinopathy), photocoagulation; (e.g., diabetic retinopathy), photocoagulation
Codes 67227 and 67228 have been revised to omit reference to “1 or more sessions,” and code 67229 has
been reformatted to appear as a stand-alone/parent code and not a subset of codes 67227 and 67228. The
introductory guidelines listed under the “Destruction” heading have been revised to omit reference to codes
67227 and 67228. In addition, the explanatory parenthetical note following code 67229 pertaining to the use of
modifier 50 has been revised for specificity to include a listing of applicable codes.
Removal of the phrase “1 or more sessions” included in the descriptors of codes 67227 and 67228 aligns the
codes with their intended use. Code 67229 retains its original intent to report the treatment of retinopathy in
infants encompassing one or multiple treatments during a 90-day global surgical package. It will appear in the
codebook as a stand-alone/parent code with the added prefatory language, “Treatment of extensive or
progressive retinopathy, 1 or more sessions.”
To increase specificity, codes 67208, 67210, 67218, 67220, 67227, 67228, and 67229 have been added to the
instructional parenthetical note following code 67229 to reference the unilateral treatment cod es that require
the use of modifier 50 when treatment is applied to both eyes.
AUDITORY SYSTEM
EXTERNAL EAR
28
REMOVAL
New
Description
Codes
69209
Removal impacted cerumen using irrigation/lavage, unilateral
Code 69209 has been established in the External Ear subsection to report the removal of impacted cerumen
by irrigation and/or lavage. In support of the establishment of code 69209, several exclusionary and
instructional parenthetical notes were added to ensure appropriate reporting of codes 69209 and 69210.
A new code was warranted to differentiate between direct and indirect approaches of removing impacted
cerumen (earwax) performed or supervised by physicians or other qualified health care professionals.
Impacted cerumen is typically extremely hard and dry and accompanied by pain and itching. Impacted
cerumen obstructing the external auditory canal and tympanic membrane can lead to hearing loss.
Code 69210 only captures the direct method of earwax removal utilizing curettes, hooks, forceps, and suction.
Another less invasive method uses a continuous low pressure flow of liquid (e.g., saline water) to gently loosen
impacted cerumen and flush it out with or without the use of a cerumen softening agent (e.g., cerumenolytic)
that may be administered days prior to the procedure or at the time of the procedure.
Code 69209 enables the irrigation or lavage method of impacted cerumen removal to be separately reported,
and not mistakenly reported with code 69210.
Codes 69209 and 69210 should not be reported together when both services are provided on the same day on
the same ear. Only one code (69209 or 69210) may be reported for the primary service (most intensive time or
27
28
Ibid at Page 410.
Ibid at Pages 418.
23
skilled procedure) provided on that day on the same ear. Two instructional parenthetical notes have been
added following codes 69209 and 69210 to exclude codes 69209 and 69210 from being reported together.
Also, to avoid misuse of either code, reciprocal parenthetical notes have been added after codes 69209 and
69210 to identify the code that utilizes the alternative methodology. If either one of the cerumen removal
procedures is done on both ears, modifier 50 should be appended as indicated in the new parenthetical note
added following codes 69209 and 69210.
The E/M codes should be reported when non-impacted cerumen is removed according to the section category
defined by the site of service (e.g., office or other outpatient, hospital care, nursing facility services) as
instructed in the parenthetical note following code 69209, and in a similar note that has been revised following
code 69210. Prior to the establishment of code 69209, the parenthetical note following code 69210 instructed
the use of E/M codes for cerumen removal by irrigation. This parenthetical note has been revised to omit
reference to the irrigation methodology, and to allow the time and resources for this procedure to be captured
in a separate reportable code apart from E/M services.
MEDICINE
In the Medicine section, nearly all of the vaccine codes (90476-90749) have been updated to include Advisory
Committee on Immunization Practices (ACIP) abbreviations, and numerous codes representing obsolete
vaccine products have been deleted. Two new codes (90620, 90621) have been added to report the
administration of serogroup B meningococcal (MenB) vaccines, and a new code (90625) to report the
administration of a live oral cholera vaccine has been added. In addition, code 91040, included in the
Gastroenterology subsection, has been revised to omit the provocation requirement and to specify the study as
diagnostic.
The Ophthalmology subsection contains minor revisions pertaining to the trabeculoplasty and retinal
detachment repair procedural codes, including editorial revisions and one code deletion. New codes for
bithermal and monothermal caloric vestibular testing (92537, 92538) have been added under the Special
Otorhinolaryngologic Services subsection. A single code (93050) has been added to the Cardiovascular
subsection to report arterial pressure waveform analysis for the assessment of central arterial pressures.
A detailed set of instructions has been added to instruct users on the proper reporting of codes 95970-95979
within the Neurostimulators, Analysis-Programming subsection.
In the Special Dermatological Procedures subsection, six new codes (96931, 96932, 96933, 96934, 96935,
96936) have been added to report reflectance confocal microscopy for cellular and sub-cellular imaging of the
skin.
Lastly, ocular screening code 99174 has been revised, and a new code (99177) has been added to
differentiate between remote and on-site analysis.
VACCINES, TOXOIDS
Revised
Codes
90632
90633
90634
90647
29
29
Description
Hepatitis A vaccine (HepA), adult dosage, for intramuscular use
Hepatitis A vaccine (HepA), pediatric/adolescent dosage-2 dose schedule, for intramuscular
use
Hepatitis A vaccine (HepA), pediatric/adolescent dosage-3 dose schedule, for intramuscular
use
Hemophilus influenza Haemophilus influenzae type b vaccine (Hib), PRP-OMP conjugate (,
Ibid at Pages 578-581
24
3 dose schedule), for intramuscular use
90648
90649
90650
90653
90655
Hemophilus influenza Haemophilus influenzae type b vaccine (Hib), PRP-T conjugate (, 4
dose schedule), for intramuscular use
Human Papilloma virus (HPV) Papillomavirus vaccine, types 6, 11, 16, 18 (quadrivalent),
quadrivalent (4vHPV), 3 dose schedule, for intramuscular use
Human Papilloma virus (HPV) Papillomavirus vaccine, types 16, 18, bivalent (2vHPV), 3
dose schedule, for intramuscular use
Influenza vaccine, inactivated (IIV), subunit, adjuvanted, for intramuscular use
90660
Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, when administered to
children 6-35 months of age, for intramuscular use
Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, when administered to
individuals 3 years and older, for intramuscular use
Influenza virus vaccine, trivalent (IIV3), split virus, when administered to children 6-35
months of age, for intramuscular use
Influenza virus vaccine, trivalent (IIV3), split virus, when administered to individuals 3 years
of age and older, for intramuscular use
Influenza virus vaccine, trivalent, live (LAIV3), for intranasal use
90672
Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use
90661
Influenza virus vaccine (ccIIV3), derived from cell cultures, subunit, preservative and
antibiotic free, for intramuscular use
Influenza virus vaccine, trivalent (RIV3), derived from recombinant DNA, hemagglutinin (HA)
protein only, preservative and antibiotic free, for intramuscular use
Influenza virus vaccine (IIV), split virus, preservative free, enhanced immunogenicity via
increased antigen content, for intramuscular use
Influenza virus vaccine, live (LAIV), pandemic formulation, live, for intranasal use
90656
90657
90658
90673
90662
90664
90666
90668
Influenza virus vaccine (IIV), pandemic formulation, split virus, preservative free, for
intramuscular use
Influenza virus vaccine (IIV), pandemic formulation, split virus, adjuvanted, for intramuscular
use
Influenza virus vaccine (IIV), pandemic formulation, split virus, for intramuscular use
90670
Pneumococcal conjugate vaccine, 13 valent (PCV13), for intramuscular use
90680
Rotavirus vaccine, pentavalent (RV5), 3 dose schedule, live, for oral us
90681
Rotavirus vaccine, human, attenuated (RV1), 2 dose schedule, live, for oral use
90685
Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, when administered
to children 6-35 months of age, for intramuscular use
Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, when administered
to individuals 3 years of age and older, for intramuscular use
Influenza virus vaccine, quadrivalent (IIV4), split virus, when administered to children 6-35
months of age, for intramuscular use;
Influenza virus vaccine, quadrivalent (IIV4), split virus, when administered to individuals 3
years of age and older, for intramuscular use
Diphtheria, tetanus toxoids, acellular pertussis vaccine and inactivated poliovirus vaccine,
inactivated (DTaP-IPV), when administered to children 4 through 6 years of age, for
intramuscular use
Diphtheria, tetanus toxoids, acellular pertussis vaccine, hHaemophilus influenza Type
B influenzae type b, and inactivated poliovirus vaccine (DTaP-IPV/Hib), for intramuscular
use
Diphtheria and tetanus toxoids adsorbed (DT) adsorbed when administered to individuals
90667
90686
90687
90688
90696
90698
90702
25
younger than 7 years, for intramuscular use
90714
90716
90732
Tetanus and diphtheria toxoids adsorbed (Td) adsorbed, preservative free, when
administered to individuals 7 years or older, for intramuscular use
Varicella virus vaccine (VAR), live, for subcutaneous use
90736
Pneumococcal polysaccharide vaccine, 23-valent (PPSV23), adult or immunosuppressed
patient dosage, when administered to individuals 2 years or older, for subcutaneous or
intramuscular use
Meningococcal conjugate vaccine, serogroups C & Y and Hemophilus influenza B
Haemophilus influenzae type b vaccine (Hib-MenCY), 4 dose schedule, when administered
to children 2-15 18 months of age, for intramuscular use
Meningococcal polysaccharide vaccine (any group(s)), serogroups A, C, Y, W-135,
quadrivalent (MPSV4), for subcutaneous use
Meningococcal conjugate vaccine, serogroups A, C, Y and W-135, quadrivalent
(MenACWY), for intramuscular use
Zoster (shingles) vaccine (HZV), live, for subcutaneous injection
90739
Hepatitis B vaccine (HepB), adult dosage, 2 dose schedule, for intramuscular use
90740
Hepatitis B vaccine (HepB), dialysis or immunosuppressed patient dosage (, 3 dose
schedule), for intramuscular use
Hepatitis B vaccine (HepB), adolescent (, 2 dose schedule), for intramuscular use
90644
90733
90734
90743
90744
90746
90747
90748
Hepatitis B vaccine (HepB), pediatric/adolescent dosage (, 3 dose schedule), for
intramuscular use
Hepatitis B vaccine (HepB), adult dosage (, 3 dose schedule), for intramuscular use
Hepatitis B vaccine (HepB), dialysis or immunosuppressed patient dosage (, 4 dose
schedule), for intramuscular use
Hepatitis B and Hemophilus influenza Haemophilus influenzae type b vaccine (HepBHib)(Hib HepB), for intramuscular use
The maintenance of the CPT code set to incorporate the Centers for Disease Control and Prevention
(CDC) Advisory Committee on Immunization Practices (ACIP) US Vaccine Abbreviations in CPT vaccine
product codes 90476-90749, which were first implemented in the CPT 2015 code set, has been continued.
The AMA’s Vaccine Coding Caucus (VCC) recommended that the ACIP US Vaccine Abbreviations be included
in the vaccine code descriptions to adequately describe the vaccine product and to capture standardized
vaccine abbreviations.
As a result, codes 90632, 90633, 90634, 90644, 90647, 90648, 90649, 90650, 90653, 90655, 90656,
90657, 90658, 90660, 90661, 90662, 90664, 90666, 90667, 90668, 90670, 90672, 90673, 90680, 90681,
90685, 90686, 90687, 90688, 90696, 90698, 90702, 90714, 90716, 90732, 90733, 90734, 90736, 90739,
90740, 90743, 90744, 90746, 90747, and 90748 have been revised to incorporate the ACIP US Vaccine
Abbreviations in the CPT vaccine product codes. In addition, vaccine abbreviations appearing in the CDC’s
Updated May 2015 listing of US Vaccine Abbreviations were incorporated into the Human Papillomavirus
vaccine codes 90651, 90620, and 90621.
During the process of incorporating ACIP abbreviations into the 2016 code set, it was discovered that
additional editorial revisions were warranted to maintain a correct code set. Thus, the following revisions were
made: substitution of the term “Haemophilus” for “Hemophilus” in codes 90647 and 90648, and the term
“Human Papilloma virus” for “Human Papillomavirus” in codes 90649 and 90650; addition of the letter “e” to
the end of “influenza” in codes 90647, 90648, and 90698; addition of the term “type” in codes 90644, 90647,
90648, 90698, and 90748; repositioning of the term “inactivated” in codes 90696 and 90698, and the ACIP
abbreviation in codes 90673, 90702, and 90714; utilization of a lowercase “b” in code 90698; utilization of an
26
uppercase “H” in the term “haemophilus” in code 90698; substitution of the term “quadrivalent” for “tetravalent”
in code 90734; resequencing code 90644 to appear in proximity to codes 90733 and 90734 (including the
addition of the resequencing symbol “#”); revision of code 90644 to match the age reflected in the product’s
updated licensed age indication (2-18 months of age instead of the former 2-15 months of age indication); and
substitution of the phrase “any groups” with specific serogroups “A, C, Y, W -135, quadrivalent” in code 90733.
The ACIP US Vaccine Abbreviations are listed in the CPT vaccine code descriptors following the full name of
the vaccine. A listing of all the revised CPT codes containing ACIP US vaccine descriptors are available on the
AMA CPT website at www.ama-assn.org/go/cpt-vaccine, and this update will continue during the
bi-annual Category I Vaccine electronic release schedule. In addition, the ACIP maintains a table of current
standardized vaccine abbreviations on the CDC website at
www.cdc.gov/vaccines/acip/committee/guidance/vac-abbrev.html.
The ACIP US Vaccine Abbreviations for combination vaccines are often separated by either a slash (/) or a
dash (-). The dash (-) signifies active components of a combination vaccine that are supplied in their final form
by the manufacturer and are ready to be administered without additional preparation. A slash (/) signifies
products in which the active components of the combination vaccine must be mixed by the user. An example
of components requiring mixing or reconstitution include DTaP-IPV/Hib.
The VCC will continue to update CPT vaccine codes to include new and revised ACIP US Vaccine
Abbreviations for release during the biannual Category 1 Vaccine electronic release schedule (January 1 and
July 1) via the AMA CPT website. The accuracy of the ACIP US Vaccine Abbreviation designations in the CPT
code set does not affect the validity of the vaccine code and its reporting function.
OBSOLETE VACCINES, TOXOIDS CODES
Deleted
Description
Codes
90645
Hemophilus influenza b vaccine (Hib), HbOC conjugate (4 dose schedule), for intramuscular use
90646
Hemophilus influenza b vaccine (Hib), PRP-D conjugate, for booster use only, intramuscular use
90669
Pneumococcal conjugate vaccine, 7 valent (PCV7), for intramuscular use
90692
Typhoid vaccine, heat- and phenol-inactivated (H-P), for subcutaneous or intradermal use
90693
90703
Typhoid vaccine, acetone-killed, dried (AKD), for subcutaneous use (U.S. military)
Tetanus toxoid adsorbed, for intramuscular use
90704
Mumps virus vaccine, live, for subcutaneous use
90705
Measles virus vaccine, live, for subcutaneous use
90706
Rubella virus vaccine, live, for subcutaneous use
90708
Measles and rubella virus vaccine, live, for subcutaneous use
90712
Poliovirus vaccine, (any type[s]) (OPV), live, for oral use
90719
Diphtheria toxoid, for intramuscular use
90720
90725
Diphtheria, tetanus toxoids, and whole cell pertussis vaccine and Haemophilus influenzae b
vaccine (DTwP-Hib), for intramuscular use
Diphtheria, tetanus toxoids, and acellular pertussis vaccine and Haemophilus influenzae b
vaccine (DTaP/Hib), for intramuscular use
Cholera vaccine for injectable use
90727
Plague vaccine, for intramuscular use
90735
Japanese encephalitis virus vaccine, for subcutaneous use
90721
27
During the process of incorporating the ACIP US Vaccine Abbreviations into the CPT code set, the VCC
received information that led it to conduct a comprehensive review of the Vaccines, Toxoids subsection to
identify obsolete codes for vaccine products that are no longer available in the United States.
As a result, 17 codes (90645, 90646, 90669, 90692, 90693, 90703, 90704, 90705, 90706, 90708, 90712,
90719, 90720, 90721, 90725, 90727, 90735) have been deleted. A deletion parenthetical note has been added
to replace each one of the 17 deleted obsolete vaccine codes. These references will remain in the CPT data
set for three year
30
GASTROENTEROLOGY
Revised
Description
Codes
91040
Esophageal balloon distension study, diagnostic, with provocation study when performed
Code 91040 has been revised to remove the provocation requirement and to specify the study as diagnostic.
Esophageal distension is generally measured in all patients who undergo esophageal balloon distension.
However, not all patients undergo provocation during the performance of the study. Therefore, removing
provocation from the code descriptor allows the reporting of this service when provocation is not performed.
Patients with esophageal disorders, such as noncardiac chest pain, achalasia, and eosinophilic esophagitis,
may undergo a diagnostic evaluation, which includes the transoral or endoscopic placement of a balloon
catheter with barostat capability into the esophagus. Pressure and dimension measurement devices are used
as an adjunct to other methods in the comprehensive evaluation of patients with symptoms consistent with
esophageal sensory hypersensitivity. The device measures the distensibility of the esophageal lumen via
inflation and deflation of the balloon in a standardized manner. Depending on the clinical presentation,
provocation may or may not be performed along with measurement of distensibility of the esophageal lumen.
Revisions to code 91040 include adding the term “diagnostic” and the phrase “when performed” to denote
that provocation is no longer required to report this service.
A parenthetical note, which has been added following code 91040, restricts the reporting of this service more
than once per session.
SPECIAL OTORHINOLARYNGOLOGIC SERVICES
31
VESTIBULAR FUNCTION TEST, WITH RECORDING
New
Description
Codes
92537
92538
Caloric vestibular test with recording, bilateral; bithermal (i.e., one warm and one cool
irrigation in each ear for a total of four irrigations)
monothermal (i.e., one irrigation in each ear for a total of two irrigations)
Two new codes (92537 and 92538) have been established in the Vestibular Function Tests, With Recording
(e.g., ENG) subsection to report bilateral caloric vestibular testing, both bithermal (92537) and monothermal
(92538). Parenthetical notes have been added to direct users regarding the intended use of these codes. As a
result of the additions, code 92543 has been deleted.
In a screen for high-volume growth services, code 92543 was identified by the AMA/Specialty Society Relative
Value Scale (RVS) Update Committee (RUC) Relativity Assessment Workgroup (RAW) in a screen for highvolume growth services in which Medicare utilization increased by 100%. Upon review of the increased use of
30
31
Ibid at Page 590.
Ibid at Page 596.
28
the code, it was found that the service as described in the code was not being accurately reported. The code
was intended to be reported per irrigation. However, the respondents noted that the procedure is usually
performed as an entire service of four irrigations, as binaural, bithermal irrigation is typically performed as four
tests. As a result, code 92543 has been deleted, and codes 92537 and 92538 have been established to
remove the ambiguity.
Based on standard practice, code 92537 is intended to report a complete caloric vestibular testing procedure
that includes bilateral performance of bithermal irrigation (i.e., one warm and one cool irrigation for each ear).
Fewer irrigation procedures require a different method of reporting according to what was done. For three
irrigations (e.g., irrigation of both ears using monothermal irrigation of one ear and bithermal irrigation of the
contralateral ear), code 92537 is reported with modifier 52 appended. Monothermal irrigation (i.e., irrigation of
both ears with either cool or warm irrigation) is reported once with code 92538. If a single ear is irrigated with a
single method of irrigation (cool or warm), code 92538 is reported once with modifier 52 appended.
Parenthetical notes that accompany the codes direct users regarding the correct reporting for each type of
irrigation. In addition, exclusionary parenthetical notes have been placed to restrict the reporting of code 92537
with code 92538, as only one code (with a modifier, if needed) should be reported for any caloric vestibular
irrigation procedure.
Deleted
Codes
92543
Description
Caloric vestibular test, each irrigation (binaural, bithermal stimulation constitutes 4 tests),
with recording
With the development of a more specific coding structure for these procedures, code 92543 has been deleted.
A parenthetical note has been added to direct users to the appropriate codes to use for reporting this service.
CARDIOGRAPHY
New
Codes
93050
32
Description
Arterial pressure waveform analysis for assessment of central arterial pressures, includes
obtaining waveform(s), digitization and application of nonlinear mathematical
transformations to determine central arterial pressures and augmentation index, with
interpretation and report, upper extremity artery, non-invasive
Category III code 0311T, which describes non-invasive calculation and analysis of central arterial pressure
waveform, has been deleted and converted to Category I code 93050, as the procedure is now performed
frequently enough to warrant Category I status. In addition, a new exclusionary parenthetical note has been
added to instruct users on the appropriate use of this code.
Code 93050 may be used to assist in managing patients with resistant hypertension. Resistant hypertension is
defined as blood pressure that remains above normal, despite the use of multiple blood pressure medications.
These patients may be at higher risk of cardiovascular morbidity and mortality and often have other cardiac
risk factors such as obesity, hyperlipidemia, and diabetes, and usually have signs or symptoms of end-organ
damage.
A parenthetical note was added following code 93050 to clarify that this service should not be reported with
any other diagnostic or interventional intra-arterial procedures.
32
Ibid at Page 604.
29
33
PULMONARY
Revised
Description
Codes
94640
Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for
sputum induction therapeutic purposes and/or for diagnostic purposes (eg,such as sputum
induction with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive
pressure breathing [IPPB](IPPB) device)
Code 94640 has been revised and exclusionary parenthetical notes have been added to the Pulmonary
Diagnostic Testing and Therapies subsection.
Code 94640 was revised to clarify the intent that this is a bundled code, representing both diagnostic and
therapeutic services. An exclusionary parenthetical note clarifies that this code may not be reported together
with codes 94060 (bronchodilator responsiveness), 94070 (bronchospasm provocation evaluation), or 94400
(breathing response to CO 2 ). The parenthetical note following code 94060 has been revised to include 94640.
Two new exclusionary parenthetical notes also follow codes 94070 and 94400 restricting their use with 94640.
NEUROLOGY AND NEUROMUSCULAR PROCEDURES 34
Revised
Description
Codes
95972
complex spinal cord, or peripheral (i.e., peripheral nerve, sacral nerve, neuromuscular)
(except cranial nerve) neurostimulator pulse generator/transmitter, with intraoperative or
subsequent programming, up to 1 hour
Deleted
Codes
95973
Description
complex spinal cord, or peripheral (i.e., peripheral nerve, sacral nerve, neuromuscular)
(except cranial nerve) neurostimulator pulse generator/transmitter, with intraoperative or
subsequent programming, each additional 30 minutes after first hour (List separately in
addition to code for primary procedure
Code 95973 has been deleted to allow the appropriate reporting of electronic analysis of implanted
neurostimulator pulse generator systems. To comply with this, code 95972 has been revised and parenthetical
and guideline language for neurostimulator analysis and programming has also been revised.
In a screen for high-volume growth services, code 95973 was identified by the AMA/Specialty Society Relative
Value Scale (RVS) Update Committee (RUC) Relativity Assessment Workgroup (RAW) as one for which
Medicare utilization increased by 100%. Upon review of the increased use of the code, it was found that the
service as described by the code descriptor was not accurately being reported. As a result, identification of the
time needed to report this service is not necessary, and the codes used to report these services do not need to
reflect time within the descriptor. Therefore, add-on code 95973 has been deleted, as this code was intended
primarily to report additional time provided for this service, and code 95972 has been revised to conform to
current practice. Any reference to code 95973 has also been expunged from language included within the
guidelines and parenthetical notes.
In addition, an instructional parenthetical note at the beginning of the section regarding the appropriate method
to report less than 30 minutes of time-based analysis for these services has been revised to remove the
reference to code 95972.
33
34
Ibid at Page 631.
Ibid at Page 644.
30
35
SPECIAL DERMATOLOGIGAL PROCEDURES
New
Description
Codes
96931
Reflectance confocal microscopy (RCM) for cellular and sub-cellular imaging of skin; image
acquisition and interpretation and report, first lesion
96932
image acquisition only, first lesion
96933
interpretation and report only, first lesion
96934
image acquisition and interpretation and report, each additional lesion (List separately in
addition to code for primary procedure)
image acquisition only, each additional lesion (List separately in addition to code for
primary procedure)
interpretation and report only, each additional lesion (List separately in addition to code for
primary procedure)
96935
96936
Six new codes (96931, 96932, 96933, 96934, 96935, and 96936) have been established in the Special
Dermatological Procedures subsection to report reflectance confocal microscopy for cellular and subcellular
imaging of skin. New parenthetical notes have also been added to instruct users on the appropriate use of
these codes.
Prior to 2016, the only CPT codes available for confocal imaging were codes 43206 and 43252. These codes
are still appropriate to report confocal endoscopy of the esophagus and the gastrointestinal tract. However,
while the technology is similar, codes 43206 and 43252 cannot be reported for confocal imaging of the skin.
New codes 96931-96936 may be reported for reflectance confocal microscopy (RCM)
imaging used anywhere external skin lesions are found.
RCM is designed for the pathologic examination of skin lesions and can image an area of skin, typically 6 x 6
mm square, with the ability to scan larger areas at multiple levels, similar to computed tomography (CT) and
magnetic resonance imaging (MRI). RCM may produce a significantly larger diagnostic sample of a skin lesion
(typically the entire lesion), allowing determination as to whether a lesion is benign, malignant, or premalignant.
36
OTHER SERVICES AND PROCEDURES
Revised
Description
Codes
Instrument-based ocular screening (e.g., photoscreening, automated-refraction), bilateral;
99174
with remote analysis and report
New
Codes
99177
Description
Instrument-based ocular screening (e.g., photoscreening, automated-refraction), bilateral;
with remote analysis and report
New code 99177 has been added and code 99174 has been revised in the Other Services and Procedures
subsection to accommodate the use of instrument-based ocular screening to screen and detect conditions,
such as amblyopia and strabismus, which are typically performed in young children. The parent code, 99174,
has been revised, distinguished by whether the technology is readily available for on-site analysis (99177) or
whether the data are transmitted to an off-site reading station (99174). In addition, exclusionary parenthetical
notes have been added or revised and placed in the appropriate locations to direct users to the appropriate
use of these codes.
35
36
Ibid at Page 654-655
Ibid at Page 665
31
The instrumentation reflected in code 99177 enables physicians to receive on-site, real-time analysis of
images, as well as obtain an instant-read based on algorithms in the instrument via a built-in pass or fail
indicator. The services included in code 99174 require that the ocular screening images captured in the office
be transmitted to a remote facility via electronic transfer for analysis with compilation of a report and findings.
The services included in code 99174 involve securing and transmitting images and remote analysis by an
outside facility to perform the readings. In contrast, the services included in code 99177 do not require the
electronic transfer of data; instead, the data analysis is automated via the instrumentation to provide an on-site
reading and report of the results via a computerized database.
As a result of the establishment of code 99177, code 99174 (formerly designated as a Category III code
0065T) has been revised to emphasize its use of off-site ocular photoscreening, as well as autorefraction. (The
description of code 99174 was expanded in the CPT 2013 code set to include the use of autorefractors.)
Automated-refraction screening is inherently included in codes 99174 and 99177 and should not be reported
separately, as it is often a built-in component of most ocular photoscreening instrumentation. Therefore, code
92015, Determination of refractive state, should not be reported in conjunction with codes 99174 and 99177.
Although the technologies and method of analyses represented in codes 99174 and 99177 may provide
similar results, both procedures involve the use of different instrumentation and location sites. To ensure that
code 99177 is not reported in conjunction with codes 99172, 99173, and 99174, exclusionary parenthetical
notes have been added following codes 99172, 99173, and 99174. In addition, codes 99172, 99173, 99174,
and 99177 should not be reported in addition to general ophthalmological services codes 92002-92014, as the
services encompassed in these codes are considered part of the diagnostic and therapeutic services in the
medical examination and evaluation described in codes 92002-92014.
Codes 99174 and 99177 represent bilateral procedures and encompass screening done on both eyes.
Unrelated services, such as evaluation and management office visit services provided at the time of the
screening, may be reported separately.
CATEGORY II
In the Category II Codes section, code 6030F has been updated to comply with the revision of the Prevention
of Catheter-Related Bloodstream Infections (CRBSI)—Central Venous Catheter Insertion Protocol
performance measure for which this code is reported. Updates were made to match the language included
within the revised measure to ensure the elements needed for compliance with the measure are stated in the
code descriptor. In addition, the information listed for code 6030F within the Alphabetical Clinical Topics Listing
has been revised.
As a result of the refinement of the specification language used for the performance measure, the descriptor
for code 6030F has been updated to match the revised measure regarding the elements needed for
compliance.
PATIENT SAFETY
Revised
6030F
1
37
Description
All elements of maximal sterile barrier technique, followed including: cap
and mask and sterile gown and sterile gloves and a large sterile sheet and hand
hygiene, skin preparation and, if ultrasound is used, sterile ultrasound techniques followed
and 2% chlorhexidine for cutaneous antisepsis (or acceptable alternative antiseptics, per
current guideline)(CRIT)1
Physician Consortium for Performance Improvement® (PCPI), www.physicianconsortium.org 38
37
Ibid at Page 686.
32
The descriptor for code 6030F has been revised to comply with the revision of the Prevention of CatheterRelated Bloodstream Infections (CRBSI)—Central Venous Catheter Insertion Protocol performance measure
for which this code is reported. The information listed for code 6030F within the Alphabetical Clinical Topics
Listing has also been revised.
As a result of the refinement of the specification language used for the performance measure, the descriptor
for code 6030F has been updated to match the revised measure regarding the elements needed for
compliance.
As stated in the Alphabetical Clinical Topics listing (available at the American Medical Association’s CPT
website at www.ama-assn.org/go/cpt-cat2), code 6030F relates to the Prevention of Catheter-Related
Bloodstream Infections (CRBSI)—Central Venous Catheter Insertion Protocol, which now identifies that sterile
techniques must be followed for all patients who undergo central venous catheter (CVC) insertion, including all
elements of maximal sterile barrier technique: hand hygiene, skin preparation, and sterile ultrasound
techniques (when ultrasound procedures are used). This revision is editorial in nature as the language
regarding what is identified as “maximal sterile barrier technique” that was previously included in the numerator
for the measure is now included in a definition section for the measure. (Refer to the American Society of
Anesthesiologists’ website at www.asahq.org for the most current listing of the language for this measure.)
This definition lists the elements that are inherently part of maximal sterile barrier technique, including cap,
mask, gown, sterile gloves, and sterile body drape. Sterile ultrasound techniques are also defined in this
section. Code 6030F now includes language that matches the performance measure as clarified.
CATEGORY III
In the Category III Codes section, the introductory guidelines have been revised to include reference to payer
coverage, and an extensive number of Category III codes have been added to cover emerging technology.
Also, some Category III codes have been converted to Category I codes, while others have been scheduled to
sunset or be archived.
Some of the emerging technologies reflected in the new Category III codes include procedures to diagnose
nocturnal epilepsy seizure events; procedures to laparoscopically place and remove esophageal sphincter
augmentation devices; advancements in interstitial or intracavitary brachytherapy services; and procedures to
treat uterine fibroids, and medical refractory movement disorders (utilizing magnetic resonance image–guided
focused ultrasound). Other Category III codes have been added to describe procedures that detect implant
stability during knee replacement arthroplasty and diagnose and manage ischemic heart disease by
myocardial strain imaging.
A new section of Category III codes has been added for the insertion, removal, and evaluation and
programming of leadless and pocketless cardiac pacemaker systems, and a new Category III code has been
added for endoscopic retrograde cholangiopancreatography with optical endomicroscopy.
In addition, two new Category III codes have been added to report multi-spectral digital skin lesion analysis to
analyze melanoma. Time-based Category III codes have been added to describe daily diabetes preventive
behavior change intervention services and oversight of the care of extracorporeal liver assist system patients.
The last two Category III codes added describe endoscopic drug eluting implants into the ethmoid sinus.
38
Ibid at Page 667.
33
39
EXPOSURE ADAPTIVE BEHAVIORTREATMENT WITH PROTOCAL MODIFICATION
New
Description
Codes
External heart rate and 3-axis accelerometer data recording up to 14 days to assess
0381T
changes in heart rate and to monitor motion analysis for the purposes of diagnosing
nocturnal epilepsy seizure events; includes report, scanning analysis with report, review
and interpretation by a physician or other qualified health care professional
0382T
review and interpretation only
0383T
0384T
0385T
0386T
External heart rate and 3-axis accelerometer data recording from 15 to 30 days to assess
changes in heart rate to monitor motion analysis for the purposes of diagnosing nocturnal
epilepsy seizure events; includes report, scanning analysis with report, review and
interpretation by a physician or other qualified health care professional
review and interpretation only
External heart rate and 3-axis accelerometer data recording more than 30 days to assess
changes in heart rate to monitor motion analysis for the purposes of diagnosing nocturnal
epilepsy seizure events; includes report, scanning analysis with report, review and
interpretation by a physician or other qualified health care professional
review and interpretation only
Six Category III codes (0381T-0386T) have been established to report external heart rate and 3-axis
accelerometer data recording. Exclusionary parenthetical notes were added following the new codes to
preclude reporting these services with other monitoring codes.
Typically, patients are asked to maintain seizure diaries to record seizure frequency, but evidence has shown
that the self-reported data can be unreliable. In order to track patient seizure-count frequency, codes 0381T0386T have been established to report data recording changes in heart rate and motion analysis for the
purposes of diagnosing nocturnal cardiac-based epilepsy seizure events. The monitor is to be worn by the
patient with epilepsy who experiences seizures during periods of rest or sleep to capture seizure event data.
The epilepsy seizure monitoring–system (0381T-0386T) is similar to the Holter monitor (93224) because of its
continuous event recording and interpretation and reporting to a physician or other qualified health care
professional. However, the epilepsy seizure monitoring–system codes (0381T-0386T) differ from the Holter
monitoring code (93224) in that they capture the target data for epilepsy seizure detection, rather than
electrocardiographic (ECG) data. The epilepsy seizure monitoring–system includes an adhesive patch
connected to a sensor that continuously detects and records ECG and 3-axis accelerometer motion data and
communicates to a base-station hub and health care professional.
The code structure has been split to identify time-based services and to allow for review and interpretation
only. For example, codes 0381T and 0382T are intended to report monitoring for up to 14 days; codes 0383T
and 0384T report monitoring from 15 to 30 days; and codes 0385T and 0386T report monitoring for more than
30 days.
40
PACEMAKER—LEADLESS AND POCKETLESS SYSTEM
New
Description
Codes
39
40
0387T
Transcatheter insertion or replacement of permanent leadless pacemaker, ventricular
0388T
Transcatheter removal of permanent leadless pacemaker, ventricular
Ibid at Pages 705-707.
Ibid at Pages 705-707.
34
0389T
0390T
0391T
Programming device evaluation (in person) with iterative adjustment of the implantable
device to test the function of the device and select optimal permanent programmed values
with analysis, review and report, leadless pacemaker system
Peri-procedural device evaluation (in person) and programming of device system
parameters before or after a surgery, procedure or test with analysis, review and report,
leadless pacemaker system
Interrogation device evaluation (in person) with analysis, review and report, includes
connection, recording and disconnection per patient encounter, leadless pacemaker
system
Five Category III codes (0387T-0391T) and guidelines under a new heading titled “Pacemaker—Leadless
and Pocketless System” have been established to report transcatheter leadless pacemaker procedures. In
addition, editorial revisions have been made to the existing Category I guidelines in the Surgery/
Cardiovascular System subsection, and new parenthetical notes have been added.
Existing CPT codes only addressed procedures for traditional pacemaker systems and did not adequately
describe the procedure of implanting a leadless pacemaker. Therefore, these codes have been established to
report leadless and pocketless system procedures.
These specific procedures were previously reported with unlisted codes 33999, Unlisted procedure, cardiac
surgery, and 93799, Unlisted cardiovascular service or procedure. Pacemakers are used to treat diagnoses,
such as bradycardia (when the heart beats too slowly); atrioventricular block (delayed electrical conduction
through the heart); and some forms of syncope (fainting) related to cardiac arrhythmia.
Traditional pacemakers require lead placement, tunneling and connecting the leads to the pacemaker, and
creation of a surgical pocket for placement of the pacemaker generator. A leadless pacemaker is placed
directly at the apex of the right ventricle, and can provide the same therapeutic functionality as a traditional
pacemaker.
Code 0387T is used to report the insertion or replacement of a leadless pacemaker, and should not be
reported in conjunction with leadless pacemaker systems device evaluation code 0389T (programming
evaluation), 0390T (peri-procedural evaluation), or 0391T (interrogation evaluation).
41
NEW CODES
New
Description
Codes
0392T
Laparoscopy, surgical, esophageal sphincter augmentation procedure, placement of
sphincter augmentation device (i.e., magnetic band)
0393T
Removal of esophageal sphincter augmentation device
Two Category III codes (0392T, 0393T) and an exclusionary parenthetical note have been established to
report laparoscopic insertion and removal of a band on the esophageal sphincter.
The addition of these codes allows accurate reporting of the surgical placement and removal of esophageal
sphincter augmentation devices for the treatment of gastroesophageal reflux disease (GERD). The procedure
involves the implantation of a permanent device (i.e., magnet band).
Codes 0392T and 0393T comprehensively describe the approach and all of the components of the
implantation and removal of the magnetic band to augment the lower esophageal sphincter (LES) to restore
the barrier function of an incompetent LES. These codes are specifically reported for the placement and
41
Ibid at Pages 706.
35
removal of a magnet band device only. An exclusionary parenthetical note has been added to restrict reporting
these services with other fundoplasty procedures, as described in codes 43279, 43280, 43281, and 43282.
42
NEW CODES
New
Description
Codes
0394T
High dose rate electronic brachytherapy, skin surface application, per fraction, includes
basic dosimetry, when performed
0395T
High does rate electronic brachytherapy, interstitial or intravavitary treatment, per fraction,
includes basic dosimetry, when performed
Code 0394T has been established, and code 0395T has been revised and renumbered to report HDR
electronic brachytherapy skin surface application or interstitial or intracavitary treatment services. In addition,
instructional and exclusionary parenthetical notes and cross-reference parenthetical notes have been added to
clarify the reporting of these services.
Existing code 0182T described HDR electronic interstitial or intracavitary brachytherapy and did not include
basic dosimetry. Due to the differences between HDR electronic brachytherapy for skin surface and HDR
electronic interstitial or intracavitary brachytherapy, a separate code for HDR surface brachytherapy treatments
for skin cancer was needed. In addition, the descriptor of existing code 0182T was revised to describe HDR
electronic brachytherapy for treating tumors other than skin tumors and include the work of basic dosimetry
calculation. The code was renumbered to 0395T. This change is in accordance with the concept permanence
principle, which dictates that new code numbers should be established if a revision to an existing code alters
the meaning of that code.
In addition, an instructional parenthetical note defining electronic brachytherapy has been added preceding the
two new codes, and exclusionary parenthetical notes indicating that the two HDR electronic brachytherapy
codes should not be reported in conjunction with code 77300, as well as several other services, have been
added. Cross-reference parenthetical notes directing the user to the new HDR radionuclide brachytherapy
services (77767-77772) have also been added. Refer to the codebook and see the Rationale for codes 7776777772 for a full discussion of these changes.
43
NEW CODES
New
Description
Codes
0396T
Intra-operative use of kinectic balance sensor for implant stability during knee
replacement arthroplasty
Code 0396T has been established for reporting the placement of a kinetic balance sensor for implant stability
during knee replacement arthroplasty, and an inclusionary parenthetical note has been added to identify the
codes with which add-on code 0396T should be reported.
Code 0396T has been established to allow reporting of the intraoperative use of a kinetic balance sensor to
detect specific balance of the tibiofemoral components during total knee arthroplasty (TKA). The technique is
used to provide quantitative measures that aid in the exact balance of the tibiofemoral components. The data
are used in a range-of-motion analysis to confirm proper component kinematics and to aid in appropriate
tibiofemoral rotational balance and alignment.
This procedure differs from other procedures that use computed tomography, magnetic resonance imaging, or
fluoroscopic imaging intraoperatively to guide navigation. Intraoperative use of kinetic balancers involves the
42
43
Ibid at Pages 706.
Ibid at Pages 706.
36
use of tibial and femoral trial measures containing sensors designed to aid tibiofemoral tissue and ligament
balance. The effort of this service is conducted after the orthopedic surgeon makes the initial femoral and tibial
cuts per his or her usual technique. Once this is completed, the sensor balance smart trial is placed on the
tibial crest at the level that is closest to being parallel to the tibial coronal plane to establish the tibial reference.
The outcome of this procedure provides information on the degree of varus and valgus variation and may lead
to improved TKA stability.
Because code 0396T is an add-on code, it is not intended to be reported independently. Therefore, an
instructional parenthetical note has been added to note the primary codes that should be reported when this
procedure is performed.
44
NEW CODES
New
Description
Codes
0397T
Endoscopic retrograde cholangiopancreatography (ercp), with optical endomicroscopy
Code 0397T has been established to describe endoscopic retrograde cholangiopancreatography (ERCP)
with optical endomicroscopy (OE).
OE is a technique for obtaining histology-like images without physical sampling and is selectively utilized in the
diagnostic evaluation of indeterminate strictures and lesions of unknown etiology in the pancreatobiliary
system to distinguish inflammatory from neoplastic lesions. OE uses in vivo microscopic imaging to facilitate
real-time cellular observation of mucosal tissue during an endoscopic procedure. The results of the OE
evaluation may guide further diagnostic evaluation and/or therapeutic management. Prior to CPT 2016, OE of
the pancreas and the biliary tract was reported with unlisted codes.
Moderate sedation is an inherent part of this procedure and is not separately reported. Parenthetical notes
have been added to provide instruction on the appropriate use of this code.
NEW CODES
New
Codes
0398T
45
Description
Magnetic resonance image guided high intensity focused ultrasound (mrgfus), stereotactic
ablation lesion, intracranial for movement disorder including stereotactic navigation and
frame placement when performed
Code 0398T has been established to report magnetic resonance image-guided high intensity focused
ultrasound (MRgFUS), and an exclusionary parenthetical note has been added to preclude reporting this
service with other stereotactic codes.
Code 0398T describes the use of focused ultrasound for noninvasive creation of an intracranial stereotactic
ablation lesion to treat medically refractory movement disorders such as essential tremor. The method involves
an ultrasound device to ablate tissue at the focal point of the beams. It is a combination of a conventional
diagnostic (MRI) scanner and a focused ultrasound delivery system (FUS).
Stereotactic radiosurgery is a similar methodology using imaging, planning, monitoring, and delivery. However,
it uses a different form of energy such as radiation versus ultrasound. As a result, code 0398T was needed to
describe an MRI–controlled focused ultrasound system to report non-invasive thermal ablation of brain tissue.
44
45
Ibid at Pages 706.
Ibid at Pages 706.
37
An exclusionary parenthetical note has been added to preclude reporting MRgFUS with cranial stereotactic
computer-assisted procedure code 61781 and stereotactic headframe application code 61800.
46
NEW CODES
New
Description
Codes
0399T
Myocardial strain imaging (quantitative assessment of myocardial mechanics using imagebased analysis of local myocardial dynamics)
Code 0399T has been established to report myocardial strain imaging for the detection of myocardial
malformation, for example, in patients undergoing chemotherapy and radiation treatments. New parenthetical
notes have been added following code 0399T to provide instructions on the appropriate reporting of this code.
Myocardial strain imaging can be used in the diagnosis and management of ischemic heart disease. Code
0399T may be performed with stress echocardiography, both at rest and immediately following stress, and
should only be reported once per session.
47
NEW CODES
New
Description
Codes
0400T
Multi-spectral digital skin lesion analysis of clinically atypical cutaneous pigmented lesions
for detection of melanomas and high risk melanocytic atypia; one to five lesions
0401T
six or more lesions
Codes 0400T and 0401T have been established to report multi-spectral digital skin lesion analysis (MSDSLA).
An exclusionary parenthetical note has been added following code 0401T to provide instruction on the
appropriate reporting of this code.
MSDSLA represents a service performed by providers utilizing new technology. Prior to determining that a
biopsy is appropriate, the MSDSLA is ordered for lesions that are declared high risk and deemed suspicious
for melanoma.
Prior to CPT 2016, MSDSLA was reported with unlisted special dermatological service or procedure code
96999.
MSDSLA is an additional imaging and analysis procedure that may typically be performed on the same day as
an evaluation and management service. MSDSLA may also be performed following whole body integumentary
photography as described by code 96904. If after performing MSDSLA it is determined that a biopsy is
necessary, skin biopsy codes 11100 and 11101 would also be reported on the same day. These services and
procedures would be separately reported if performed, as they are not inclusive components of codes 0400T
and 0401T.
NEW CODES
New
Codes
0402T
46
47
48
48
Description
Collagen cross-linking of cornea (including removal of the corneal epithelium and
intraoperative pachymetry when performed)
Ibid at Pages 706.
Ibid at Pages 707.
Ibid at Pages 707.
38
Code 0402T has been established to report the corneal collagen cross-linking (CXL) procedure.
The objective of CXL is to stop or slow down the degradation of corneal collagen in conditions such as corneal
ectasia (e.g., keratoconus). Keratoconus (KC) is characterized by progressive thinning and steepening of the
cornea that induces irregular astigmatism and sometimes scarring, resulting in impaired vision quality. The
management of KC has mainly consisted of visual rehabilitation using glasses, contact lenses, and
intracorneal ring segment (ICRS) implantation for early-to-moderate stages, and lamellar or penetrating
keratoplasty for advanced stages characterized by contact lens intolerance and/or corneal scarring.
CXL typically involves irradiating the cornea with ultraviolet-A (UV-A) light while introducing a photosensitizer
(riboflavin or vitamin B2). When activated by the UV-A, riboflavin forms covalent bonds or cross-links in the
corneal stroma causing a stiffening effect on the corneal stroma, which may stabilize it and increase its
resistance to wear down.
This new treatment often requires the removal of the epithelium (65435) and/or the introduction of agents to
increase the permeability of the epithelium to the UV-A light, and is included in code 0402T. Therefore, code
65435 should not be reported separately. Intraoperative pachymetry (76514) to measure the corneal thickness
and use of the operating microscope (69990) are also components of code 0402T and should not be reported
separately. Exclusionary parenthetical notes have been added to prevent the misuse of codes 65435, 69990,
and 76514 in conjunction with code 0402T.
Code 0402T has been added to the list of codes found in the guidelines preceding code 69990 that cannot be
combined or reported with code 69990, Microsurgical techniques, requiring use of operating microscope (List
separately in addition to code for primary procedure).
NEW CODES
New
Codes
0403T
49
Description
Preventive behavior change, intensive program of prevention of diabetes using a
standardized diabetes prevention program curriculum, provided to individuals in a group
setting, minimum 60 minutes, per day
Code 0403T has been established to address the delivery of a diabetes prevention program that uses a
standardized curriculum in a group format intending to prevent the onset of an established illness, namely
diabetes.
With the increased frequency of these programs, the addition of code 0403T addresses the need for collection
and analysis of utilization data tracked as a preventive health service. Because this code represents a
prevention program, the participants do not have an established diabetes diagnosis and may not be
symptomatic but are at a high risk of developing type 2 diabetes. Risk factors related to
prediabetes and the prevention of prediabetes progressing to type 2 diabetes are addressed. The groups are
generally community-based and peer-led using a defined curriculum. Code 0403T is a time-based code that is
reported per day.
Code 0403T is different from current codes in the CPT code set because it describes a prevention program
using a standardized diabetes prevention curriculum. For educational services using a standardized curriculum
provided to patients with an established illness/disease by a qualified nonphysician health care professional,
codes 98960-98962 may be appropriate.
49
Ibid at Pages 707.
39
50
NEW CODES
New
Description
Codes
0404T
Transcervical uterine fibroid(s) ablation with ultrasound guidance, radiofrequency
Code 0404T has been established to report transcervical ablation of uterine fibroids.
The addition of code 0404T allows accurate reporting for the use of radiofrequency energy through an
ultrasound-guided, incision-free transcervical approach for the treatment of uterine fibroids. This method
includes an intrauterine ultrasound probe in combination with a radiofrequency ablation device in a single hand
piece. The ultrasound guidance is typically used for identification of individual fibroids.
The procedure described in code 0404T is similar to other ablation of uterine fibroid procedures (58545,
0336T, and 0071T). However, the other procedures are done via either major surgical procedure or the use of
radiation to ablate the fibroids.
NEW CODES
New
Codes
0405T
51
Description
Oversight of the care of an extracorporeal liver assist system patient requiring review of
status, review of laboratories and other studies, and revision of orders and liver assist care
plan (as appropriate), within a calendar month, 30 minutes or more of non-face-to-face time
Code 0405T has been established to report oversight of the care of an extracorporeal liver assist system
patient.
This code tracks the enrollment of patients into the clinical trial of this system and captures the services related
to oversight of the patient’s care.
Code 0405T describes 30 minutes or more of non-face-to-face time. The oversight of the care of an
extracorporeal liver assist system patient is separate from critical care and other evaluation and management
services.
NEW CODES 52
New
Codes
Description
0406T
Nasal endoscopy, surgical, ethmoid sinus, placement of drug eluting implant
0407T
Nasal endoscopy, surgical, ethmoid sinus, placement of drug eluting implant; with biopsy,
polypectomy or debridement
Codes 0406T and 0407T have been established to report the endoscopic placement of a drug eluting implant
into the ethmoid sinus, and exclusionary parenthetical notes have been added to limit the use of these codes
with other specific sinus endoscopy codes or with each other when performed on the same side.
Codes 0406T and 0407T describe endoscopic placement of a drug eluting stent either as a stand-alone
procedure (0406T) or in follow-up to a previous biopsy, polypectomy, or debridement in the ethmoid sinus
(0407T).
50
51
52
Ibid at Pages 707.
Ibid at Pages 707.
Ibid at Pages 707.
40
Nasal endoscopy procedure codes include the effort of performing the endoscopy, the packing used
postsurgery, and the placement of any stent or implant used to maintain patency of the cavity. Therefore, the
placement of a drug eluting implant during a sinus surgery is inherently included as part of the procedure and
would not be separately reported with code 0406T or 0407T. Codes 0406T and 0407T describe (1) the
endoscopic placement of an implant device when performed independently of other ethmoid sinus endoscopy
procedures; or (2) the placement during the postoperative period if complications occur that require re-entry for
treatment. In these events, the services are separately reportable using the newly established codes.
Codes 0406T and 0407T describe procedures performed in the ethmoid sinuses only.
As indicated in the exclusionary parenthetical notes, these codes may not be reported in conjunction with
codes 31200, 31201, 31205, 31231, 31237, 31240, 31254, 31255, 31288, 31290, or with each other, when
performed on the same side. However, if endoscopic placement of a drug eluting implant is performed on the
opposite side, the appropriate procedure code should be reported, as creation of a separate access site is
required. Modifier 59 should be appended to the additional code to indicate it is a distinct procedural service.
53
REVISED CODES
Revised
Description
Codes
Insertion of ocular telescope prosthesis including removal of crystalline lens or intraocular
0308T
lens prosthesis
Code 0308T has been revised to include the removal of an intraocular lens prosthesis at the time of placement
of the ocular telescope.
Code 0308T describes the implantation of a prosthetic intraocular telescope in which a crystalline lens or an
intraocular lens is removed. Previously, code 0308T only included the removal of a crystalline lens; the code
now includes the removal of an intraocular lens prosthesis. For CPT 2016, removal of either a crystalline lens
or an intraocular lens prosthesis is included.
54
REVISED CODES
Revised
Description
Codes
0358T
Bioelectrical impedance analysis whole body composition assessment, supine position, with
interpretation and report
Code 0358T has been revised to remove the reference to “supine position.”
In CPT 2015, code 0358T was established to report bioelectrical impedance analysis (BIA) for whole body
composition assessment in the supine position with interpretation and report. Removing “supi ne position” from
the code descriptor now allows all methods (e.g., supine, standing, sitting position) of BIA to utilize the code.
DELETED CODES
Deleted
Codes
0099T
Description
Implantation of intrastromal corneal ring segments
Category III code 0099T has been deleted and converted to Category I code 65785.
53
54
Ibid at Page 699.
Ibid at Page 701.
41
Deleted
Codes
0103T
Description
Holotranscobalamin, quantitative
In accordance with CPT guidelines for archiving Category III codes, code 0103T has been deleted.
Because this code was intended for reporting testing for holotranscobalamin (a laboratory procedure), the
unlisted code 84999 within the Pathology and Laboratory/Chemistry subsection should be used to identify
quantitative holotranscobalamin testing.
Deleted
Codes
0123T
Description
Fistulization of sclera for glaucoma, through ciliary body
In accordance with CPT guidelines for archiving Category III codes, code 0123T has been deleted.
Because this code was intended for reporting an eye procedure, the unlisted code 66999 within the
Surgery/Eye and Ocular Adnexa subsection should be used to identify fistulization of the sclera for glaucoma.
Deleted
Code
0182T
Description
High dose rate electronic brachytherapy, per fraction
Code 0182T for high dose rate (HDR) electronic brachytherapy has been revised and renumbered.
The revision of code 0182T altered the meaning of the code’s intent, which required that the concept
permanence principle be applied. This means the existing code must be deleted and assigned a new
number(s). The procedure under the new codes is HDR electronic brachytherapy, and the difference is that it
now includes basic dosimetry, when performed, and has been split into two codes depending on whether the
HDR is surface or interstitial/intracavitary. Refer to the codebook and the Rationale for Category III codes
0394T and 0395T for a full discussion of these changes.
Deleted
Codes
0223T
0224T
0225T
Description
Acoustic cardiography, including automated analysis of combined acoustic and electrical
intervals; single, with interpretation and report
multiple, including serial trended analysis and limited reprogramming of device parameter,
AV or VVdelays only, with interpretation and report
multiple, including serial trended analysis and limited reprogramming of device parameter,
AV andVV delays, with interpretation and report
In accordance with CPT guidelines for archiving Category III codes, codes 0223T, 0224T, and 0225T have been
deleted.
This deletion includes both the code listing and guideline language included within the Category III code
section for these codes. Deletion of these three codes also affects language included in other sections of the
CPT code set via the deletion of reference to codes 0223T, 0224T, and 0225T within a parenthetical note in the
Medicine/Cardiovascular subsection. In lieu of citing the deleted codes, parenthetical notes have been revised
within the Medicine section and added to the Category III code section to direct users to use unlisted Medicine
code 93799, when reporting acoustic cardiography procedures.
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Deleted
Codes
0233T
Description
Skin advanced glycation endproducts (AGE) measurement by multi-wavelength
fluorescent spectroscopy
In accordance with CPT guidelines for archiving Category III codes, code 0233T has been deleted.
This change affects the code listing that was included in the Category III code section. The deletion of this
code also affects language included in other sections of the CPT code set via the deletion of reference to code
0233T within a parenthetical note in the Pathology section of the code set. In lieu of citing the deleted code,
parenthetical notes have been revised within the Pathology and Laboratory section and added to the Category
III code section to direct users to use unlisted Pathology and Laboratory code 88749, when reporting skin
advanced glycation endproducts measurement by multi-wavelength fluorescent spectroscopy.
Deleted
Codes
0240T
0241T
Description
Esophageal motility (manometric study of the esophagus and/or gastroesophageal
junction) study with interpretation and report; with high resolution esophageal pressure
topography
with stimulation or perfusion during high resolution esophageal pressure topography study
(eg,stimulant, acid or alkali perfusion) (List separately in addition to code for primary
procedure)
In accordance with CPT guidelines for archiving Category III codes, codes 0240T and 0241T have been
deleted.
This change affects both the code listing and parenthetical language included within the Category III code
section. Deletion of these two codes also affects language included in other sections of the CPT code set via
the deletion of reference to codes 0240T and 0241T within a parenthetical note in the
Medicine/Gastroenterology subsection. In lieu of citing the deleted codes, parenthetical notes have been
revised within the Medicine section and added to the Category III code section to direct users to use unlisted
Medicine code 91299, when reporting high resolution esophageal pressure topography procedures.
Deleted
Codes
0243T
0244T
Description
Intermittent measurement of wheeze rate for bronchodilator or bronchial-challenge
diagnostic evaluation(s), with interpretation and report
Continuous measurement of wheeze rate during treatment assessment or during sleep for
documentation of nocturnal wheeze and cough for diagnostic evaluation 3 to 24 hours,
with interpretation and report
In accordance with CPT guidelines for archiving Category III codes, codes 0243T and 0244T have been
deleted.
Unlisted Medicine Pulmonary code 94799 should be reported for intermittent measurement of wheeze rate for
bronchodilator or bronchial challenge diagnostic evaluation.
Deleted
Codes
0262T
Description
Implantation of catheter-delivered prosthetic pulmonary valve, endovascular approach
Code 0262T has been deleted and converted to a Category I code (33477).
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Previously, code 0262T described implantation of a pulmonary valve using an endovascular approach for
implantation. The new code describes a transcatheter approach and includes pre-stenting of the valve delivery
site, when performed. Refer to the codebook and see the Rationale for code 33477 for a full discussion of the
changes.
Deleted
Codes
0311T
Description
Non-invasive calculation and analysis of central arterial pressure waveforms with
interpretation and report
A new deletion parenthetical note has been added to indicate that code 0311T has been deleted; as this
service has been converted to Category I code 93050.
DISCLAIMER:
This is an overview of the 2016 CPT and Modifier changes affecting all specialties excluding Pathology/Laboratory, Radiology,
Emergency Medicine and Anesthesia. Please refer to your 2016 CPT® Book, HCPCS Book and Payer Bulletins for additional
information. HCPCS additions, deletions and changes are not reflected in this document.
McKesson Business Performance Services (BPS) is one of several business units within McKesson Technology Solutions. PST Services,
Inc. is the legal entity BPS uses with contracts with its clients or third-party vendors.
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2015 PST, Inc. and/or one of its subsidiaries. All rights reserved. All other product or company names mentioned may be trademarks,
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financial, investment or other professional advice. Any business decisions should be made in consultation with your personal legal,
professional and accounting advisors.
CPT® copyright 2015 American Medical Association. All rights reserved.
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