Medicaid Prior Authorization
Date: 12/31/25
Michigan Meridian Medicaid requires prior authorization (PA) as a condition of payment for many services. This Notice contains information regarding such prior authorization requirements and is applicable to all Medicaid products offered by Michigan Meridian Medicaid.
Michigan Meridian Medicaid is committed to delivering cost effective quality care to our members. This effort requires us to ensure that our members receive only treatment that is medically necessary according to current standards of practice. Prior authorization is a process initiated by the physician in which we verify the medical necessity of a treatment in advance using independent objective medical criteria and/or in network utilization, where applicable.
It is the ordering/prescribing provider’s responsibility to determine which specific codes require prior authorization.
Please verify eligibility and benefits prior to rendering services for all members. Payment, regardless of authorization, is contingent on the member’s eligibility at the time service is rendered. NON-PAR PROVIDERS & FACILITIES REQUIRE AUTHORIZATION FOR ALL HMO SERVICES EXCEPT WHERE INDICATED.
For complete CPT/HCPCS code listing, please see the Medicaid Online Prior Authorization Tool.
| Service Category | Service | Procedure Codes |
|---|---|---|
| Administrative & Quality | Quality Reporting & Performance Measures | G9477 |
| Anesthesia Services | Interventional Pain Management (Nerve Blocks) | 0213T, 0214T, 0215T, 0216T, 0217T, 0218T, 0628T, 0630T, 0777T, 64400, 64405, 64408, 64415, 64416, 64417, 64418, 64420, 64421, 64430, 64445, 64446, 64447, 64448, 64449, 64450, 64451, 64454, 64461, 64462, 64463, 64466, 64467, 64468, 64469, 64473, 64474, 64479, 64483, 64486, 64487, 64488, 64489, 64490, 64493, 64505, 64510, 64517, 64520, 64530, 64624, 64625, 64628, 64629, 64633, 64635, G0260 |
| Behavioral Health & Substance Use | Alcohol and drug management, treatment, and rehabilitation | H0004, H0036, H2014, H2017, H2019, H2022, H2027 |
| Psychological and psychiatric evaluation and therapy | 0889T, 0890T, 0891T, 0892T, 90847, 90853, 90867, 90868, 90899 | |
| Cardiovascular & Thoracic Procedures | Conversion of cardiac rhythm | 92960, 92961, 93609, 93613, 93619, 93620, 93621, 93622, 93623, 93650, 93653, 93654, 93655, 93656, 93657, 93662, C9784 |
| Coronary artery bypass graft (CABG) | 33510, 33511, 33512, 33513, 33514, 33516, 33517, 33518, 33519, 33521, 33522, 33523, 33530, 33533, 33534, 33535, 33536, 33542, 33548, 33768, S2205, S2206, S2207, S2208, S2209 | |
| Embolectomy and Endarterectomy | 35301, 35302, 35303, 35304, 35305, 35306, 35351, 35355, 35371, 35372, 35390 | |
| Heart valve procedures | 0643T, 0644T, 0645T, 0646T, 33340, 33361, 33362, 33363, 33364, 33365, 33366, 33367, 33368, 33369, 33405, 33406, 33410, 33411, 33412, 33413, 33418, 33419, 33425, 33426, 33427, 33430, 33440, 33465, 33475, 33477, 33572, 33641, 33820, 33840, 33917, 33924, 33930, 33933, 33935, 33940, 33944, 33945 | |
| Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator | 0682T, 33202, 33203, 33206, 33207, 33208, 33210, 33211, 33212, 33213, 33214, 33215, 33216, 33217, 33218, 33220, 33221, 33222, 33223, 33224, 33225, 33226, 33227, 33228, 33229, 33230, 33231, 33233, 33234, 33235, 33236, 33237, 33240, 33241, 33243, 33244, 33249, 33254, 33255, 33256, 33262, 33263, 33264, 33265, 33266, 33270, 33271, 33272, 33273, 33274, 33275, 33285, 33286, 33289 | |
| Lobectomy, Pneumonectomy, and Mediastinal Procedures | 0681T, 31599, 31899, 32491, 32672, 32850, 32851, 32852, 32853, 32854, 32855, 32856, 32999, 39499 | |
| Mechanical Circulatory Support and Transplantation | 33999 | |
| Percutaneous transluminal coronary angioplasty (PTCA) | 0235T, 92920, 92921, 92924, 92925, 92928, 92929, 92933, 92934, 92937, 92938, 92943, 92944, 92973, 92974, 92978, 92979, 92986, 92987, 92997, 92998, C9600, C9601, C9602, C9603, C9604, C9605, C9606, C9607, C9608 | |
| Peripheral vascular bypass | 35001, 35011, 35141, 35151, 35400, 35500, 35556, 35558, 35566, 35571, 35572, 35583, 35585, 35587, 35600, 35621, 35646, 35654, 35656, 35661, 35665, 35666, 35671, 35700, 35881, 35883, 35884, 37215, 37220, 37221, 37224, 37225, 37226, 37227, 37228, 37229, 37230, 37231, 37232, 37233, 37234, 37235, 37236, 37237, 37238, 37239, 37243, 37246, 37247, 37248, 37249 | |
| Varicose vein stripping, lower limb | 36465, 36466, 36468, 36470, 36473, 36474, 36475, 36476, 36478, 36479, 36482, 36483, 37501, 37700, 37718, 37722, 37735, 37760, 37761, 37765, 37766, 37780, 37785 | |
| Vascular Repairs, Open Trauma, and Ligation | 37799 | |
| Consultation & Evaluation Services | Consultation, evaluation, and preventative care | 0893T, 99078, 99183, 99199, G0182, G0302, G0303, G0304, G0305, G3002, S0255, S0271, S9975, S9976, S9977 |
| Dental Services | Oral and Dental Services | 0964T, 0965T, 0966T, D0120, D0140, D0145, D0150, D0160, D0170, D0171, D0180, D0190, D0191, D0210, D0220, D0230, D0240, D0250, D0251, D0270, D0272, D0273, D0274, D0277, D0310, D0320, D0321, D0322, D0330, D0340, D0350, D0360, D0362, D0364, D0365, D0366, D0367, D0368, D0369, D0370, D0371, D0372, D0373, D0374, D0380, D0381, D0382, D0383, D0384, D0385, D0386, D0387, D0388, D0389, D0391, D0393, D0394, D0395, D0396, D0411, D0412, D0414, D0415, D0416, D0417, D0418, D0419, D0422, D0423, D0425, D0431, D0460, D0470, D0472, D0473, D0474, D0475, D0476, D0477, D0478, D0479, D0480, D0481, D0482, D0483, D0484, D0485, D0486, D0600, D0601, D0602, D0603, D0605, D0606, D0706, D0707, D0708, D0709, D0999, D1110, D1120, D1203, D1204, D1206, D1208, D1310, D1320, D1321, D1330, D1351, D1352, D1353, D1354, D1355, D1510, D1516, D1517, D1520, D1526, D1527, D1551, D1552, D1553, D1556, D1557, D1558, D1575, D1706, D1707, D1708, D1709, D1710, D1711, D1712, D1713, D1714, D1781, D1782, D1783, D1999, D2140, D2150, D2160, D2161, D2330, D2331, D2332, D2335, D2390, D2391, D2392, D2393, D2394, D2410, D2420, D2430, D2510, D2520, D2530, D2542, D2543, D2544, D2610, D2620, D2630, D2642, D2643, D2644, D2650, D2651, D2652, D2662, D2663, D2664, D2710, D2712, D2720, D2721, D2722, D2740, D2750, D2751, D2752, D2753, D2780, D2781, D2782, D2783, D2790, D2791, D2792, D2794, D2799, D2910, D2915, D2920, D2921, D2928, D2929, D2930, D2931, D2932, D2933, D2934, D2940, D2949, D2950, D2951, D2952, D2953, D2954, D2955, D2956, D2957, D2960, D2961, D2962, D2971, D2975, D2976, D2980, D2981, D2982, D2983, D2989, D2990, D2991, D2999, D3110, D3120, D3220, D3221, D3222, D3230, D3240, D3310, D3320, D3330, D3331, D3332, D3333, D3346, D3347, D3348, D3351, D3352, D3353, D3355, D3356, D3357, D3410, D3421, D3425, D3426, D3428, D3429, D3430, D3431, D3432, D3450, D3460, D3470, D3471, D3472, D3473, D3501, D3502, D3503, D3910, D3911, D3920, D3921, D3950, D3999, D4210, D4211, D4212, D4230, D4231, D4240, D4241, D4245, D4249, D4260, D4261, D4263, D4264, D4265, D4266, D4267, D4268, D4270, D4271, D4273, D4274, D4275, D4276, D4277, D4278, D4283, D4285, D4286, D4322, D4323, D4341, D4342, D4346, D4355, D4381, D4910, D4920, D4921, D4999, D5110, D5120, D5130, D5140, D5211, D5212, D5213, D5214, D5221, D5222, D5223, D5224, D5225, D5226, D5227, D5228, D5282, D5283, D5284, D5286, D5410, D5411, D5421, D5422, D5511, D5512, D5520, D5611, D5612, D5621, D5622, D5630, D5640, D5650, D5660, D5670, D5671, D5710, D5711, D5720, D5721, D5725, D5730, D5731, D5740, D5741, D5750, D5751, D5760, D5761, D5765, D5810, D5811, D5820, D5821, D5850, D5851, D5862, D5863, D5864, D5865, D5866, D5867, D5875, D5876, D5899, D5911, D5912, D5913, D5914, D5915, D5916, D5919, D5922, D5923, D5924, D5925, D5926, D5927, D5928, D5929, D5931, D5932, D5933, D5934, D5935, D5936, D5937, D5951, D5952, D5953, D5954, D5955, D5958, D5959, D5960, D5982, D5983, D5984, D5985, D5986, D5987, D5988, D5991, D5992, D5993, D5995, D5996, D5999, D6010, D6011, D6012, D6013, D6040, D6050, D6051, D6055, D6056, D6057, D6058, D6059, D6060, D6061, D6062, D6063, D6064, D6065, D6066, D6067, D6068, D6069, D6070, D6071, D6072, D6073, D6074, D6075, D6076, D6077, D6080, D6081, D6082, D6083, D6084, D6085, D6086, D6087, D6088, D6089, D6090, D6091, D6092, D6093, D6094, D6096, D6097, D6098, D6099, D6100, D6101, D6102, D6103, D6104, D6105, D6106, D6107, D6110, D6111, D6112, D6113, D6114, D6115, D6116, D6117, D6118, D6119, D6120, D6121, D6122, D6123, D6180, D6190, D6191, D6192, D6193, D6194, D6195, D6197, D6198, D6199, D6205, D6210, D6211, D6212, D6214, D6240, D6241, D6242, D6243, D6245, D6250, D6251, D6252, D6253, D6254, D6545, D6548, D6549, D6600, D6601, D6602, D6603, D6604, D6605, D6606, D6607, D6608, D6609, D6610, D6611, D6612, D6613, D6614, D6615, D6624, D6634, D6710, D6720, D6721, D6722, D6740, D6750, D6751, D6752, D6753, D6780, D6781, D6782, D6783, D6784, D6790, D6791, D6792, D6793, D6794, D6795, D6920, D6930, D6940, D6950, D6970, D6972, D6973, D6976, D6977, D6980, D6985, D6999, D7111, D7140, D7210, D7220, D7230, D7240, D7241, D7250, D7251, D7252, D7259, D7260, D7261, D7270, D7272, D7280, D7282, D7283, D7284, D7285, D7286, D7287, D7288, D7290, D7291, D7292, D7293, D7294, D7295, D7296, D7297, D7298, D7299, D7300, D7310, D7311, D7320, D7321, D7340, D7350, D7410, D7411, D7412, D7413, D7414, D7415, D7440, D7441, D7450, D7451, D7460, D7461, D7465, D7471, D7472, D7473, D7485, D7490, D7509, D7510, D7511, D7520, D7521, D7530, D7540, D7550, D7560, D7610, D7620, D7630, D7640, D7650, D7660, D7670, D7671, D7680, D7710, D7720, D7730, D7740, D7750, D7760, D7770, D7771, D7780, D7810, D7820, D7830, D7840, D7850, D7852, D7854, D7856, D7858, D7860, D7865, D7870, D7871, D7872, D7873, D7874, D7875, D7876, D7877, D7880, D7881, D7899, D7910, D7911, D7912, D7920, D7921, D7922, D7939, D7940, D7941, D7943, D7944, D7945, D7946, D7947, D7948, D7949, D7950, D7951, D7952, D7953, D7955, D7956, D7957, D7961, D7962, D7963, D7970, D7971, D7972, D7979, D7980, D7981, D7982, D7983, D7990, D7991, D7993, D7994, D7995, D7996, D7997, D7998, D7999, D8010, D8020, D8030, D8040, D8070, D8080, D8090, D8091, D8210, D8220, D8660, D8670, D8671, D8680, D8681, D8695, D8696, D8697, D8698, D8699, D8701, D8702, D8703, D8704, D8999, D9110, D9120, D9130, D9210, D9211, D9212, D9215, D9219, D9222, D9223, D9230, D9239, D9243, D9248, D9310, D9311, D9410, D9420, D9430, D9440, D9450, D9610, D9612, D9613, D9630, D9910, D9911, D9912, D9913, D9914, D9920, D9930, D9932, D9933, D9934, D9935, D9938, D9939, D9941, D9942, D9943, D9944, D9945, D9946, D9947, D9948, D9949, D9950, D9951, D9952, D9953, D9954, D9955, D9956, D9957, D9959, D9961, D9970, D9971, D9972, D9973, D9974, D9975, D9985, D9986, D9987, D9990, D9991, D9992, D9993, D9994, D9995, D9996, D9997, D9999 |
| Diagnostic Cardiology | Diagnostic cardiac catheterization, coronary arteriography | 93451, 93452, 93453, 93454, 93455, 93456, 93457, 93458, 93459, 93460, 93461, 93462, 93463, 93464, 93505, 93563, 93564, 93565, 93566, 93567, 93568, 93571, 93572, 93580, 93581, 93582, 93583, 93590, 93591, 93592, C7504, C7505, C7507, C7508 |
| Diagnostic ultrasound of heart (echocardiogram) | 93303, 93304, 93306, 93307, 93308, 93312, 93313, 93314, 93315, 93316, 93317, 93318, 93350, 93351 | |
| Electroencephalogram (EEG), Sleep Studies, and Neurodiagnostics | 95782, 95783 | |
| Electrographic cardiac monitoring | 0695T, 0696T, 0716T, 0897T, 0949T, 0962T, 93292 | |
| Diagnostic Neurology | Electroencephalogram (EEG) and Sleep Studies | 95803, 95805, 95807, 95808, 95810, 95811, 95851, 95852 |
| Diagnostic Radiology & Imaging | Arterio- or Venogram (Including Aortography) | 36005, 36140, 36200, 36215, 36216, 36217, 36218, 36221, 36245, 36246, 36247, 36251, 36252, 36253, 36254, 36299, 75625, 75630, 75635, 75710, 75716, 75726, 75736 |
| Computerized axial tomography (CT) Imaging | 0042T, 0174T, 0624T, 0691T, 0710T, 0711T, 0712T, 0713T, 0721T, 0877T, 0878T, 0879T, 0880T, 70450, 70460, 70470, 70480, 70481, 70482, 70486, 70487, 70488, 70490, 70491, 70492, 70496, 70498, 71250, 71260, 71270, 71271, 71275, 72125, 72126, 72127, 72128, 72129, 72130, 72131, 72132, 72133, 72191, 72192, 72193, 72194, 72198, 73200, 73201, 73202, 73206, 73700, 73701, 73702, 73706, 73718, 73719, 73720, 73721, 73722, 73723, 73725, 74150, 74160, 74170, 74174, 74175, 74176, 74177, 74178, 74261, 74262, 74263, 75571, 75572, 75573, 75574, G0288 | |
| Magnetic resonance imaging (MRI/MRA) | 0648T, 0649T, 0723T, 0898T, 0899T, 0900T, 70540, 70542, 70543, 70544, 70545, 70546, 70547, 70548, 70549, 70551, 70552, 70553, 70554, 70555, 71550, 71551, 71552, 71555, 72141, 72142, 72146, 72147, 72148, 72149, 72156, 72157, 72158, 72159, 72195, 72196, 72197, 73218, 73219, 73220, 73221, 73222, 73223, 73225, 74181, 74182, 74183, 74185, 74712, 74713, 75557, 75559, 75561, 75563, 77046, 77047, 77048, 77049, C8900, C8901, C8902, C8903, C8905, C8906, C8908, C8909, C8910, C8911, C8912, C8913, C8914, C8918, C8919, C8920, C8931, C8932, C8933, C8934, C8935, C8936, S8037, S8042 | |
| Mammography | 0351T, 0353T, 0694T | |
| Other diagnostic ultrasound | 0690T, 0876T, 76937, 76999 | |
| Radioisotope scan, PET, and Nuclear Medicine | 0742T, 78099, 78199, 78299, 78399, 78429, 78430, 78431, 78432, 78433, 78451, 78452, 78453, 78454, 78459, 78466, 78468, 78469, 78472, 78473, 78481, 78483, 78491, 78492, 78494, 78499, 78599, 78608, 78609, 78699, 78799, 78811, 78812, 78813, 78814, 78815, 78816, 78999, G0341, G0342, G0343 | |
| Standard X-Ray and Radiography | 70336, 76380, 76390, 76496, 76497, 76498, 76499, 77078, 77084 | |
| Dialysis & Nephrology Services | Hemodialysis and Peritoneal Dialysis | 0692T, G0495, G0496 |
| Durable Medical Equipment (DME) | DME and supplies | A4100, A4238, A4239, A4271, A4421, A4438, A4564, A4593, A4594, A4615, A4619, A4649, A6501, A6502, A6503, A6504, A6505, A6506, A6507, A6508, A6509, A6510, A6511, A6512, A6513, A6545, A6576, A6577, A6579, A6580, A8003, E0152, E0194, E0241, E0242, E0243, E0260, E0261, E0265, E0266, E0294, E0295, E0296, E0297, E0301, E0302, E0303, E0304, E0316, E0328, E0329, E0434, E0445, E0457, E0465, E0466, E0468, E0469, E0470, E0471, E0482, E0483, E0490, E0491, E0616, E0625, E0630, E0635, E0636, E0637, E0638, E0639, E0641, E0642, E0650, E0651, E0652, E0655, E0656, E0657, E0658, E0659, E0660, E0665, E0666, E0667, E0668, E0669, E0670, E0671, E0672, E0673, E0683, E0715, E0721, E0736, E0737, E0738, E0739, E0743, E0745, E0747, E0748, E0760, E0766, E0767, E0783, E0784, E0954, E0983, E0984, E0986, E1002, E1004, E1007, E1012, E1017, E1018, E1032, E1033, E1034, E1050, E1161, E1229, E1230, E1231, E1232, E1233, E1234, E1235, E1236, E1237, E1238, E1239, E1391, E1399, E1639, E1832, E2102, E2103, E2104, E2230, E2291, E2292, E2293, E2294, E2295, E2298, E2301, E2311, E2313, E2321, E2323, E2324, E2326, E2327, E2328, E2329, E2330, E2331, E2370, E2375, E2378, E2386, E2392, E2402, E2500, E2502, E2504, E2506, E2508, E2510, E2511, E2512, E2599, E2609, E2617, E8000, E8001, E8002, K0003, K0004, K0005, K0006, K0007, K0009, K0015, K0017, K0018, K0020, K0037, K0040, K0041, K0042, K0044, K0045, K0046, K0047, K0050, K0051, K0052, K0053, K0056, K0108, K0606, K0607, K0608, K0609, K0800, K0801, K0802, K0806, K0807, K0808, K0812, K0813, K0814, K0815, K0816, K0820, K0821, K0822, K0823, K0824, K0825, K0826, K0827, K0828, K0829, K0830, K0831, K0835, K0836, K0837, K0838, K0839, K0840, K0841, K0842, K0843, K0848, K0849, K0850, K0851, K0852, K0853, K0854, K0855, K0856, K0857, K0858, K0859, K0860, K0861, K0862, K0863, K0864, K0868, K0869, K0870, K0871, K0877, K0878, K0879, K0880, K0884, K0885, K0886, K0890, K0891, K0898, K1036, Q0477, Q0515, Q3031, Q4025, Q4050, Q4051, S1040, S8092, S8422, S8423, S8425, S8426, T4521, T4522, T4523, T4524 |
| Enteral & Parenteral Therapy (Formula/Pumps) | B4100, B4103, B4105, B4155, B4158, B4159, B4160, B4161, B4162, B4187, B9998, B9999 | |
| Orthotics, Prosthetics, and OPPS Devices | C1730, C1731, C1732, C1733, C1735, C1736, C1737, C1742, C1753, C1759, C1760, C1764, C1768, C1777, C1779, C1785, C1786, C1826, C1827, C1832, C1876, C1877, C1882, C1895, C1896, C1898, C1899, L0112, L0464, L0480, L0482, L0484, L0486, L0632, L0634, L0637, L0648, L0650, L0700, L0710, L0720, L0999, L1000, L1001, L1005, L1006, L1007, L1200, L1300, L1320, L1499, L1653, L1681, L1690, L1700, L1710, L1755, L1833, L1844, L1846, L1932, L1933, L1952, L2034, L2036, L2037, L2128, L2627, L2628, L2861, L2999, L3160, L3170, L3201, L3202, L3203, L3204, L3206, L3207, L3224, L3225, L3230, L3250, L3251, L3252, L3253, L3254, L3255, L3257, L3265, L3300, L3310, L3320, L3330, L3332, L3334, L3340, L3350, L3360, L3370, L3380, L3400, L3430, L3440, L3450, L3455, L3460, L3465, L3470, L3808, L3891, L3904, L3927, L3999, L4631, L4645, L5000, L5010, L5020, L5050, L5060, L5100, L5105, L5150, L5160, L5200, L5210, L5220, L5230, L5250, L5270, L5280, L5301, L5312, L5321, L5331, L5341, L5500, L5505, L5510, L5520, L5530, L5535, L5540, L5560, L5570, L5580, L5590, L5595, L5600, L5610, L5611, L5613, L5616, L5618, L5620, L5622, L5624, L5626, L5628, L5629, L5630, L5631, L5632, L5634, L5636, L5637, L5638, L5639, L5640, L5642, L5644, L5645, L5646, L5648, L5650, L5651, L5652, L5653, L5654, L5655, L5656, L5657, L5658, L5666, L5668, L5670, L5671, L5672, L5673, L5676, L5678, L5679, L5680, L5681, L5682, L5683, L5684, L5685, L5686, L5688, L5690, L5692, L5694, L5695, L5696, L5697, L5698, L5699, L5700, L5701, L5702, L5703, L5704, L5705, L5706, L5707, L5710, L5712, L5714, L5716, L5718, L5722, L5724, L5726, L5728, L5780, L5783, L5810, L5812, L5816, L5818, L5822, L5824, L5827, L5828, L5830, L5840, L5841, L5845, L5850, L5855, L5856, L5859, L5920, L5925, L5950, L5962, L5964, L5966, L5970, L5971, L5972, L5974, L5975, L5976, L5978, L5979, L5980, L5981, L5982, L5984, L5987, L5990, L5991, L5999, L6000, L6010, L6020, L6028, L6029, L6031, L6032, L6033, L6034, L6035, L6036, L6038, L6039, L6050, L6055, L6100, L6110, L6120, L6130, L6200, L6205, L6250, L6300, L6350, L6400, L6450, L6500, L6550, L6570, L6600, L6605, L6610, L6615, L6616, L6620, L6625, L6628, L6629, L6630, L6635, L6637, L6640, L6641, L6642, L6645, L6646, L6647, L6650, L6655, L6660, L6665, L6670, L6672, L6675, L6676, L6677, L6680, L6682, L6684, L6686, L6687, L6688, L6689, L6690, L6691, L6692, L6693, L6694, L6695, L6696, L6697, L6698, L6700, L6706, L6707, L6708, L6709, L6711, L6712, L6713, L6714, L6721, L6722, L6805, L6810, L6881, L6883, L6884, L6885, L6890, L6895, L6935, L7186, L7400, L7401, L7402, L7403, L7404, L7405, L7406, L7499, L7510, L7520, L7600, L7700, L8000, L8001, L8002, L8015, L8020, L8030, L8499, L8500, L8501, L8509, L8510, L8515, L8607, L8608, L8614, L8615, L8616, L8617, L8618, L8619, L8624, L8629, L8691, L8692, L8693, L8698, L8720 | |
| Ear, Nose & Throat (ENT) Surgery | Diagnostic procedures on nose, mouth, pharynx, and ear | 0881T, 0955T, 0978T, 0979T, 0980T, 30520, 30620, 30630, 30999, 31276, 31295, 31296, 31298, 31299, 40899, 41599, 41899, 42145, 42299, 42699, 42820, 42825, 42826, 42830, 42831, 42835, 42836, 42999, 69399, 69716, 69799, 69930, 69949, 69979 |
| Gastroenterology Procedures | Colonoscopy and biopsy | S2142 |
| Gastrostomy, temporary and permanent | 0647T | |
| Sigmoidoscopy, proctoscopy, and anoscopy | 0963T, 0967T, 45399, 45999, 46999, S2140 | |
| Upper gastrointestinal endoscopy (and Diagnostics) | 0651T, 0652T, 0653T, 0654T, 0736T, 0977T | |
| Upper gastrointestinal endoscopy (and Diagnostics) (and Diagnostics) | 0868T, 91299 | |
| General & Abdominal Surgery | Appendectomy | 44979 |
| Cholecystectomy and common duct exploration | 47579, 47999 | |
| Exploratory laparotomy (and Major Open Abdominal) | 45499, 47133, 47135, 47140, 47141, 47142, 47143, 47144, 47145, 47146, 47147, 47379, 47380, 47381, 47399, 48551, 48552, 48554, 48556, 48999, 49999, 60659, 60699, S2102 | |
| Gastric bypass and volume reduction (Bariatric) | 43289, 43290, 43291, 43499, 43644, 43645, 43647, 43648, 43659, 43770, 43771, 43772, 43773, 43775, 43842, 43843, 43845, 43846, 43847, 43848 | |
| Gastric, Esophageal, and Bariatric Structural Surgery | 43881, 43882, 43888, 43999 | |
| Laparoscopy | 44238, 49329 | |
| Other hernia repair | 39599, 49505, 49591, 49593, 49595, 49650, 49659 | |
| Small bowel resection/ Resection & Stoma | 44132, 44133, 44135, 44136, 44137, 44715, 44720, 44721, 44799, 44899 | |
| Gynecological Surgery | Hysterectomy, abdominal and vaginal | 0664T, 0665T, 0666T, 0667T, 0668T, 0669T, 0670T, 58150, 58180, 58260, 58262, 58290, 58291, 58541, 58542, 58543, 58550, 58552, 58553, 58554, 58570, 58571, 58572, 58573 |
| Minor Gyn, Non-Hysterectomy & Maternity | 56625, 56800, 56805, 57110, 57291, 57292, 57335, 58350, 58578, 58579, 58999, 59840, 59841, 59850, 59851, 59852, 59855, 59856, 59857, 59866, 59897, 59898, 59899, S9002 | |
| Other gynecological surgery (Ovary/Tubal) | 58661, 58662, 58679, 58720 | |
| Hematology & Oncology Procedures | Bone marrow transplant | 38204, 38240, 38241, 38242, S2150 |
| Lymph Node and Hemic System Surgery | 38129, 38589, 38999 | |
| Therapeutic radiology (Radiation Oncology) | 0659T, 77299, 77399, 77499, 77799, 79999, C1721, C1722, C2617, C2619, C2620, C2621, C2623, C2624, C2630 | |
| Home Health & Community Services | Home Infusion Services | 99601, 99602, S9562 |
| Private Duty Nursing/Aide (T-Codes) | T1002, T1003, T1025 | |
| Supplemental & State-Waiver Services | 0731T, A9156, A9268, A9269, A9274, A9276, A9277, A9291, A9999, C1062, S5165, T5001 | |
| Integumentary Procedures | Blepharoplasty and Brow Procedures | 15820, 15821, 15822, 15823, 67900, 67901, 67902, 67903, 67904, 67906, 67908, 67909, 67911, 67914, 67915, 67916, 67917, 67921, 67922, 67923, 67924, 67950, 67999 |
| Breast Reconstruction and Mastectomy | 19300, 19301, 19303, 19316, 19318, 19325, 19328, 19330, 19340, 19342, 19350, 19355, 19357, 19370, 19371, 19396, 19499, S2053, S2054, S2055 | |
| Complex Reconstruction & Grafts (Skin Substitutes) | Q4101, Q4107, Q4110, Q4113, Q4115, Q4121, Q4132, Q4133, Q4160, Q4173, Q4186, Q4195, Q4196, Q4199, Q4204, Q4205, Q4224, Q4225, Q4234, Q4236, Q4248, Q4250, Q4256, Q4257, Q4258, Q4259, Q4260, Q4261, Q4262, Q4263, Q4264, Q4265, Q4274, Q4281, Q4285, Q4286, Q4305, Q4306, Q4307, Q4308, Q4309, Q4310, Q4311, Q4312, Q4313, Q4314, Q4315, Q4316, Q4317, Q4318, Q4319, Q4320, Q4321, Q4322, Q4323, Q4324, Q4325, Q4326, Q4327, Q4328, Q4329, Q4330, Q4331, Q4332, Q4333, Q4336, Q4337, Q4338, Q4339, Q4340, Q4341, Q4342, Q4343, Q4344, Q4345, Q4346, Q4347, Q4348, Q4349, Q4350, Q4351, Q4352, Q4353, Q4354, Q4355, Q4356, Q4357, Q4358, Q4359, Q4360, Q4361, Q4362, Q4363, Q4364, Q4365, Q4366, Q4367, Q4368, Q4369, Q4370, Q4371, Q4372, Q4373, Q4375, Q4376, Q4377, Q4378, Q4379, Q4380, Q4381, Q4382, Q4383, Q4384, Q4385, Q4386, Q4387, Q4388, Q4389, Q4390, Q4391, Q4392, Q4393, Q4394, Q4395, Q4396, Q4397 | |
| Debridement of wound, infection or burn | 0640T, 0658T, 0859T, 0860T, 0972T, 0973T, 0974T, 0975T, 11042, 15999, 96931, 96932, 96933, 96934, 96935, 96936 | |
| Excision of skin lesion | 0970T | |
| Skin graft | 15271, 15272, 15273, 15274, 15275, 15276, 15277, 15278, 15734, 15736, 15738, 15771, 15772, 15773, 15774, 15775, 15776, A2003, A2011, A2012, A2013, A2014, A2015, A2016, A2017, A2018, A2022, A2023, A2024, A2025, A2026, A2027, A2028, A2029, A2030, A2031, A2032, A2033, A2034, A2035, A2036, A2037, A2038, A2039 | |
| Wound Repair & Destruction of Lesions | 17340, 17360, 17380, 17999 | |
| Laboratory & Pathology Services | Genetic and Molecular Testing | 0006M, 0011M, 0012M, 0013M, 0015M, 0016M, 0017M, 0020M, 81105, 81106, 81107, 81108, 81109, 81110, 81111, 81112, 81120, 81121, 81161, 81162, 81163, 81164, 81165, 81166, 81167, 81168, 81170, 81171, 81172, 81173, 81174, 81175, 81176, 81177, 81178, 81179, 81180, 81181, 81182, 81183, 81184, 81185, 81186, 81187, 81188, 81189, 81190, 81191, 81192, 81193, 81194, 81200, 81201, 81202, 81203, 81204, 81205, 81206, 81207, 81208, 81209, 81210, 81212, 81215, 81216, 81217, 81218, 81219, 81221, 81222, 81223, 81224, 81225, 81226, 81227, 81228, 81229, 81230, 81231, 81232, 81233, 81234, 81236, 81237, 81238, 81239, 81240, 81241, 81242, 81243, 81247, 81248, 81249, 81250, 81251, 81252, 81253, 81254, 81255, 81256, 81257, 81258, 81259, 81260, 81269, 81271, 81272, 81273, 81274, 81276, 81277, 81278, 81279, 81283, 81284, 81285, 81286, 81287, 81288, 81289, 81290, 81291, 81292, 81293, 81294, 81295, 81296, 81297, 81298, 81299, 81300, 81301, 81302, 81303, 81304, 81305, 81306, 81307, 81308, 81309, 81311, 81312, 81313, 81314, 81317, 81318, 81319, 81320, 81321, 81322, 81323, 81324, 81325, 81326, 81327, 81328, 81329, 81330, 81332, 81333, 81334, 81335, 81336, 81337, 81338, 81339, 81343, 81344, 81345, 81346, 81347, 81348, 81350, 81351, 81352, 81353, 81355, 81357, 81360, 81361, 81362, 81363, 81364, 81370, 81371, 81372, 81373, 81374, 81375, 81376, 81377, 81378, 81379, 81380, 81381, 81382, 81383, 81400, 81401, 81402, 81403, 81404, 81405, 81406, 81407, 81408, 81410, 81411, 81412, 81413, 81414, 81415, 81416, 81417, 81418, 81419, 81422, 81425, 81426, 81427, 81430, 81431, 81434, 81435, 81437, 81439, 81440, 81441, 81442, 81443, 81445, 81448, 81449, 81450, 81451, 81455, 81456, 81457, 81458, 81459, 81460, 81462, 81463, 81464, 81465, 81470, 81471, 81479, 81490, 81493, 81500, 81503, 81504, 81506, 81517, 81518, 81520, 81521, 81522, 81523, 81525, 81529, 81538, 81539, 81540, 81541, 81542, 81546, 81551, 81552, 81554, 81595, 81599, S3800, S3840, S3841, S3842, S3844, S3845, S3846, S3849, S3850, S3852, S3853, S3861, S3865, S3866, S3870 |
| Immunology | 86812, 86813, 86816, 86817, 86821, 86849, 86999 | |
| Laboratory - Chemistry, Hematology, and Blood Bank | 81099, 84999, 85999, 89240, 89398 | |
| Laboratory - Chemistry, Hematology, and Specimen Collection | C8000, C8005 | |
| Microscopic examination (bacterial, toxicology, COVID-19) | 87483, 87593, 87999, G0480, G0481, G0482, G0483 | |
| Pathology | 0751T, 0752T, 0753T, 0754T, 0755T, 0756T, 0757T, 0758T, 0759T, 0760T, 0761T, 0762T, 0763T, 88099, 88199, 88230, 88233, 88235, 88240, 88241, 88245, 88248, 88249, 88261, 88262, 88263, 88264, 88267, 88269, 88271, 88272, 88273, 88274, 88275, 88280, 88283, 88285, 88289, 88291, 88299, 88364, 88365, 88366, 88369, 88373, 88374, 88377, 88399 | |
| Proprietary Lab Analyses (PLA Codes) | 0002U, 0003U, 0005U, 0009U, 0010U, 0016U, 0017U, 0018U, 0019U, 0021U, 0023U, 0026U, 0027U, 0031U, 0032U, 0033U, 0034U, 0036U, 0040U, 0045U, 0046U, 0047U, 0049U, 0060U, 0063U, 0080U, 0083U, 0090U, 0092U, 0101U, 0163U, 0169U, 0170U, 0171U, 0173U, 0174U, 0175U, 0177U, 0179U, 0180U, 0181U, 0182U, 0183U, 0184U, 0185U, 0186U, 0187U, 0188U, 0189U, 0190U, 0191U, 0192U, 0193U, 0194U, 0195U, 0196U, 0197U, 0198U, 0199U, 0200U, 0201U, 0203U, 0205U, 0209U, 0211U, 0212U, 0213U, 0214U, 0215U, 0216U, 0217U, 0218U, 0219U, 0220U, 0221U, 0222U, 0239U, 0242U, 0243U, 0244U, 0245U, 0246U, 0247U, 0248U, 0249U, 0250U, 0252U, 0253U, 0254U, 0256U, 0258U, 0260U, 0261U, 0262U, 0263U, 0264U, 0265U, 0266U, 0267U, 0268U, 0269U, 0270U, 0271U, 0272U, 0273U, 0274U, 0276U, 0277U, 0278U, 0282U, 0285U, 0286U, 0287U, 0288U, 0289U, 0290U, 0291U, 0292U, 0293U, 0294U, 0295U, 0296U, 0297U, 0298U, 0299U, 0300U, 0306U, 0307U, 0308U, 0309U, 0310U, 0313U, 0314U, 0315U, 0317U, 0318U, 0319U, 0320U, 0322U, 0327U, 0329U, 0331U, 0333U, 0334U, 0335U, 0336U, 0339U, 0341U, 0343U, 0345U, 0347U, 0348U, 0349U, 0350U, 0420U, 0421U, 0422U, 0423U, 0424U, 0425U, 0426U, 0433U, 0434U, 0436U, 0437U, 0438U, 0439U, 0440U, 0443U, 0444U, 0449U, 0452U, 0453U, 0454U, 0457U, 0458U, 0459U, 0460U, 0461U, 0462U, 0463U, 0465U, 0466U, 0467U, 0468U, 0469U, 0470U, 0472U, 0473U, 0474U, 0475U, 0476U, 0477U, 0478U, 0479U, 0480U, 0481U, 0485U, 0486U, 0487U, 0488U, 0489U, 0493U, 0494U, 0495U, 0496U, 0497U, 0498U, 0499U, 0500U, 0501U, 0502U, 0503U, 0506U, 0507U, 0508U, 0509U, 0510U, 0511U, 0516U, 0531U, 0532U, 0533U, 0534U, 0536U, 0537U, 0538U, 0539U, 0540U, 0543U, 0544U, 0549U, 0552U, 0553U, 0554U, 0555U, 0560U, 0561U, 0562U, 0565U, 0566U, 0567U, 0568U, 0569U, 0571U, 0575U, 0576U, 0577U, 0578U, 0579U, 0582U, 0583U, 0585U, 0586U, 0591U, 0592U, 0596U, 0597U, 0598U, 0599U | |
| Medication & Pharmacy | Medications (Injections, infusions and other forms) | 0708T, 0709T, 0732T, A9607, C1605, C1606, C1900, C9047, C9089, C9257, C9305, C9399, J0121, J0122, J0129, J0172, J0174, J0175, J0177, J0178, J0179, J0180, J0185, J0202, J0208, J0210, J0215, J0218, J0219, J0220, J0221, J0222, J0223, J0225, J0256, J0257, J0287, J0289, J0291, J0348, J0364, J0480, J0485, J0490, J0491, J0517, J0565, J0567, J0577, J0578, J0584, J0585, J0586, J0587, J0588, J0589, J0593, J0596, J0597, J0598, J0599, J0601, J0602, J0603, J0604, J0605, J0606, J0607, J0608, J0609, J0630, J0637, J0638, J0668, J0691, J0717, J0738, J0743, J0752, J0775, J0791, J0801, J0802, J0879, J0881, J0885, J0888, J0889, J0895, J0896, J0897, J1072, J1096, J1202, J1203, J1260, J1267, J1290, J1299, J1301, J1302, J1303, J1306, J1307, J1324, J1325, J1412, J1414, J1434, J1437, J1438, J1439, J1440, J1442, J1447, J1453, J1454, J1455, J1456, J1458, J1459, J1460, J1551, J1552, J1554, J1555, J1556, J1557, J1558, J1559, J1560, J1561, J1562, J1566, J1568, J1569, J1570, J1572, J1575, J1576, J1599, J1602, J1626, J1627, J1628, J1632, J1640, J1645, J1650, J1652, J1655, J1726, J1738, J1740, J1743, J1744, J1745, J1748, J1786, J1809, J1823, J1826, J1830, J1930, J1931, J1932, J1943, J1944, J1954, J2020, J2062, J2170, J2182, J2212, J2248, J2260, J2267, J2277, J2278, J2280, J2315, J2320, J2323, J2325, J2327, J2329, J2350, J2351, J2353, J2354, J2355, J2356, J2357, J2358, J2407, J2410, J2426, J2427, J2428, J2430, J2468, J2501, J2504, J2506, J2507, J2513, J2545, J2562, J2680, J2700, J2724, J2770, J2777, J2778, J2779, J2781, J2782, J2786, J2787, J2793, J2797, J2798, J2801, J2802, J2820, J2840, J2860, J2910, J2941, J2993, J2995, J2998, J3000, J3030, J3031, J3032, J3060, J3070, J3090, J3095, J3111, J3240, J3241, J3243, J3245, J3246, J3247, J3262, J3280, J3285, J3299, J3305, J3320, J3357, J3358, J3364, J3380, J3385, J3391, J3396, J3397, J3402, J3403, J3465, J3471, J3472, J3473, J3490, J3590, J3591, J7170, J7171, J7172, J7173, J7174, J7175, J7177, J7179, J7180, J7181, J7182, J7183, J7185, J7186, J7187, J7188, J7189, J7190, J7191, J7192, J7193, J7194, J7195, J7196, J7197, J7198, J7199, J7200, J7201, J7202, J7203, J7204, J7205, J7207, J7208, J7209, J7210, J7211, J7212, J7213, J7214, J7308, J7309, J7310, J7311, J7312, J7313, J7314, J7318, J7320, J7321, J7322, J7323, J7324, J7325, J7326, J7327, J7328, J7329, J7331, J7332, J7345, J7351, J7352, J7354, J7356, J7501, J7504, J7511, J7513, J7521, J7525, J7599, J7648, J7649, J7658, J7659, J8499, J8541, J8655, J8999, J9024, J9038, J9054, J9161, J9210, J9212, J9213, J9226, J9314, J9332, J9361, J9376, J9381, J9999, M0224, Q0138, Q0139, Q0162, Q0166, Q0180, Q0224, Q2026, Q3027, Q5101, Q5103, Q5104, Q5106, Q5108, Q5109, Q5110, Q5111, Q5120, Q5121, Q5122, Q5124, Q5125, Q5128, Q5130, Q5133, Q5134, Q5135, Q5136, Q5147, Q5148, Q5149, Q5150, Q5151, Q5152, Q5153, Q5154, Q5155, Q5156, Q5157, Q5158, Q5159, Q9991, Q9992, Q9996, Q9997, Q9998, Q9999, S0013, S0080, S0189, S0190, S0191, S0199 |
| Neurosurgery | Incision and excision of CNS | 0662T, 0663T, 0735T, 61736, 61737, 63620, 64999 |
| Insertion of catheter or spinal stimulator | 0674T, 0675T, 0676T, 0677T, 0678T, 0679T, 0680T, 0767T, 0969T, 62320, 62321, 62322, 62323, 62324, 62325, 62326, 62327, 62350, 62351, 62360, 62361, 62362, 62380, 63650, 63655, 63661, 63662, 63663, 63664, 63685, 63688, 64555, 64561, 64566, 64568, 64590 | |
| Non-Hospital & Outpatient Services | Nonhospital-based care (e.g., home health care, hospice) | G0151, G0152, G0156, G0157, G0158, G0159, G0160, G0299, G0300, G0493, G0494, G0529, G0530, G0531, Q5001, Q5002, Q5003, Q5004, Q5005, Q5006, Q5007, Q5008, Q5009, Q5010, Q5098, Q5099, Q5100, S9126, S9129, S9131 |
| Ophthalmology & Vision Care | General Eye Exams & Diagnostics | 0333T, 0687T, 0688T, 0704T, 0705T, 0706T, 92065 |
| Glaucoma & Eyeball Procedures | 0253T, 0308T, 0329T, 0660T, 0661T, 0730T, 67299, 67399, 67599, 68399, 68899 | |
| Lens and cataract procedures | 66999 | |
| Visual aids and other optical supplies | 92310, 92311, 92312, 92313, 92326, 92499, V2500, V2501, V2510, V2511, V2513, V2520, V2521, V2523, V2526, V2531, V2599, V2629 | |
| Orthopedic & Spine Surgery | Foot & Ankle Surgery | 28899 |
| General Orthopedics, Trauma, & Fracture Treatment | 0200T, 0201T, 0232T, 0717T, 0718T, 0869T, 20560, 20561, 20999, 21089, 21120, 21121, 21122, 21123, 21125, 21127, 21137, 21138, 21139, 21141, 21142, 21143, 21145, 21146, 21147, 21150, 21151, 21154, 21155, 21159, 21160, 21172, 21175, 21179, 21180, 21181, 21182, 21183, 21184, 21188, 21193, 21194, 21195, 21196, 21198, 21199, 21206, 21208, 21209, 21210, 21215, 21230, 21235, 21240, 21242, 21243, 21244, 21245, 21246, 21247, 21248, 21249, 21255, 21256, 21260, 21261, 21263, 21267, 21268, 21270, 21275, 21280, 21282, 21295, 21296, 21299, 21499, 21899, 22101, 22102, 22103, 22110, 22112, 22114, 22116, 22220, 22222, 22224, 22532, 22856, 22857, 22858, 22861, 22862, 22864, 22865, 22867, 22869, 22899, 22999, 23120, 23125, 23130, 23700, 23929, 24363, 24366, 24370, 24371, 24999, 25332, 25441, 25442, 25443, 25444, 25445, 25446, 25999, 26989, 27096, 27125, 27278, 27279, 27299, 27403, 27405, 27407, 27409, 27412, 27415, 27416, 27418, 27420, 27422, 27424, 27425, 27427, 27428, 27429, 27438, 27570, 27599, 27702, 27899 | |
| Major Joint Reconstruction & Arthroscopy | 23405, 23410, 23412, 23415, 23420, 23430, 23450, 23455, 23460, 23462, 23465, 23466, 23470, 23472, 23473, 23474, 27130, 27132, 27134, 27137, 27138, 27332, 27333, 27446, 27447, 27486, 27487, 29805, 29806, 29807, 29819, 29820, 29821, 29822, 29823, 29824, 29825, 29826, 29827, 29828, 29860, 29861, 29862, 29863, 29866, 29867, 29868, 29870, 29873, 29874, 29875, 29876, 29877, 29879, 29880, 29881, 29882, 29883, 29884, 29885, 29886, 29887, 29888, 29889, 29899, 29914, 29915, 29916, 29999, G0289, S2118 | |
| Orthopedic Supplies, Casting, & Wound Care | 29799 | |
| Spine Surgery (Fusion, Laminectomy, & Deformity) | 0202T, 0219T, 0220T, 0221T, 0222T, 0656T, 0657T, 0719T, 0790T, 22533, 22548, 22551, 22552, 22554, 22558, 22590, 22595, 22600, 22612, 22614, 22630, 22633, 22830, 22836, 22837, 22847, 22848, 22849, 63001, 63003, 63005, 63011, 63012, 63015, 63016, 63017, 63020, 63030, 63040, 63042, 63045, 63046, 63047, 63050, 63051, 63055, 63056, 63064, 63066, 63075, 63077, 63078, 63085, 63086, 63185, 63190, 63191, C9757, G0277, G0278 | |
| Physical, Occupational, and Speech Therapy | Chiropractic Services | 98940, 98941, 98942 |
| PT/OT/Speech therapy | 0693T, 0733T, 0734T, 97110, 97112, 97113, 97116, 97124, 97129, 97130, 97139, 97140, 97150, 97153, 97155, 97530, 97533, 97535, 97537, 97542, 97545, 97546, 97550, 97551, 97552, S8948, S9090 | |
| Therapy Modalities (Ultrasound, Traction, Stim) | 97010, 97012, 97014, 97016, 97018, 97022, 97024, 97026, 97028, 97032, 97033, 97034, 97035, 97036, 97039, 97750, 97755, 97760, 97761, 97763, 97799, G0283 | |
| Plastic & Reconstructive Surgery | Cosmetic & Functional Reconstructive Surgery | 15780, 15781, 15782, 15783, 15786, 15788, 15789, 15792, 15793, 15824, 15825, 15826, 15828, 15829, 15830, 15832, 15833, 15834, 15835, 15836, 15837, 15838, 15839, 15876, 15877, 15878, 15879, 40799 |
| Plastic procedures on nose (Rhinoplasty) | 30400, 30410, 30420, 30430, 30435, 30450, 30460, 30462 | |
| Speech, Language, and Hearing Services | Hearing and Speech Evaluations | 0725T, 0726T, 0727T, 0728T, 0729T, 92507, 92508, 92526, 92700 |
| Hearing devices and audiology supplies | V5030, V5040, V5050, V5060, V5100, V5120, V5130, V5140, V5171, V5172, V5181, V5200, V5211, V5212, V5213, V5214, V5215, V5240, V5242, V5243, V5244, V5245, V5246, V5247, V5248, V5249, V5250, V5251, V5252, V5253, V5254, V5255, V5258, V5259, V5274, V5298, V5299 | |
| Telehealth Services | Telehealth (calls, online communication, remote monitoring) | 0175T, 0650T |
| Therapeutic Injections & Infusions | Injections: muscles, tendons, bursa, joints, soft tissue | 11950, 11951, 11952, 11954, 11960 |
| Prophylactic vaccinations and inoculations admin | 90749 | |
| Vaccine and Immune Globulin Products | 90378, 90399 | |
| Transportation Services | Transportation - patient, provider, equipment | A0170, A0426, A0428, A0430, A0431, A0435, A0436, A0999 |
| Uncategorized | General | 01966, 01999 |
| Urological & Kidney Surgery | Diagnostic procedures, male genital | 0864T, 54125, 55899 |
| Diagnostic procedures, male genital (includes minor surgery) | 54520, 54660, 54690, 54699, 55175, 55180, 55559 | |
| Kidney transplant | 50300, 50320, 50323, 50325, 50327, 50328, 50329, 50340, 50360, 50365, 50370, 50380, S2065 | |
| Nephrectomy and Major Urinary Tract Reconstruction | 0672T, 50547, 50548, 50549, 50949, 51999, 53430, 54360, 54400, 54401 | |
| Other diagnostic procedures of urinary tract | 53899 | |
| Transurethral resection of prostate (TURP) | 0655T, 0714T, 0950T |