I

..

Republic ofthe Philippines

PHILIPPINE HEALTH INSURANCE CORPORATION
Citystate Centre, 709 Shaw BoulevarcL Pasig City
Healthline 637-9999 www.philhealth.gov.ph

PHILHEALTH CIRCULAR
No. ...1Q_, s-2009

.g;,

TO

ALL ACCREDITED
INSTITUTIONAL AND
PROFESSIONAL HEALTH CARE PROVIDERS,
MEMBERS OF PHILHEALTH, PHILHEALTH
PERSONNEL AND~ OTHERS CONCERNED

SUBJECT

Revised Value Scale for 2009 with Additional Procedures

PhilHealth is mandated by law to adapt to changes in medial technology to meet the needs
of its members. As stated .in Section 39 of the Implementing Rules and Regulation of RA
7875 (as amended by RA 9241) PhilHealth slull introduce additional benefit. items and
continuously improve the system for benefits availm:ent.

Pursuant to PhilHealth Board Resolution No.1207 series of 2009, amendments to the RVS
2001 include:

1. Fifteen additional procedures to wit

CODE

DESCRIPTIVE TE RMS

31636

Bronchoscopy; diagnostic, (flexible or rigid),with placement of bronchial

stents
with placement of catherer:s for intracavitary .radioelement application
High intensity focused ultrasound (HIFU) of the prostate including
ca.nsuretb.r:al.resection of the prostate (I1JRP)
D.rainage and debridement of Foumier's gangrene of the scroru:m
T ubo wbal anutomosis
Manual vacuum aspiration for spontaneous abortion
O cular sutface reconstruction; amniotic membrane transplantation
limbal stem cdl allogaft: (e.g., acbvanc ox: living donor)
limbal conjunctival autograft (tncludes obtaining graft)
ExtracapsuW: cataract .removal with insertion o f intraocular lens prosthesis
(one stage procedure), manll21 or mecha.nial teeh.nique (e.g., irrigation and
aspiration or phacoemulsifiation), complex, requiring devices or techniques
no t gene.rally used in routine cata.tact surgery (e.g., iris expansion device,
suture support for intra.ocuW: lens, or primary posterior capsullo:.rhexis) o.r
performed on patients in the amblyoge:nic developmental stage
Implantation of inttavitreal dmg delivery system (e.g., ganciclovir implant),
includes concomitant removal of vitreous
Huvesting conjunctiVal allograft, living donor
Angiography, fluorescein (eye)

31643
52649
55101
58750
59814
65780
65781
65782

66982

67027
68371
75757
92980
92981

RVU

T.tanscatheter placement of an intra.coro~ stent(s), percutaneous, with o.r

without other therapeuac interventions, any m ethod; single vessel

- - .-- 11 - '....'71 A.~]l

each additional vessel

...

100
250
25
100

so
200
200
200

.
200

170
120

so
200
200

ill ~.-lftfit. "-~. acno

O.t:
4

.L

100

--~fjq1'oq~

'
CUill'IED

UE COPY

I I P A I.', e

2. Revision of relative value units (RVU) of selected procedures currently found in the RVS
will be revised as listed in the attached Annex of this Circular.
3. In addition, to pmperl.y guide all concemed in the implementation of this c:irculaJ:, the
ground rules for RVS 2001 shall remain in effect until its revision.

'Ibis Circular shall take effect for all claims starting April 1, 2009 admissions. All other
issuances inconsistent herewith are hereby modified or repealed accordingly.
Please be

u
\X

DR. REY B QUINO

President and CEO

Date signed:

'\

2 1Page

ANNEX

CODE
10060
10080
10120
10140
10160
11050
11051
11100
11300
11301
11302
11303
11305
11306
11307
11308
11310
11311
11312
11313
11400

DESCRIPTIVE TERMS
Incision and drainage of abscess (e.g., carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or
paronychia)
Incision and drainage of pilonidal cyst
Incision and removal of foreign body, subcutaneous tissues
Incision and drainage of hematoma, seroma, or fluid collection
Puncture aspiration of abscess, hematoma, bulla, or cyst
Paring or curettement of benign hyperkeratotic skin lesion w/ or w/o chemical cauterization (such as verrucae or clavi) not
extending through the stratum corneum (e.g., callus or wart) w/ or w/o local anesthesia; single lesion
two to four lesions
Biopsy of skin, subcutaneous tissue and/or mucous membrane (including simple closure), unless otherwise listed ; single or
multiple lesion
Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less
lesion diameter 0.6 to 1.0 cm
lesion diameter 1.1 to 2.0 cm
lesion diameter over 2.0 cm
Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less
lesion diameter 0.6 to 1.0 cm
lesion diameter 1.1 to 2.0 cm
lesion diameter over 2.0 cm
Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose ,lips, mucous membrane; lesion diameter 0.5 cm or
less
lesion diameter 0.6 to 1.0 cm
lesion diameter 1.1 to 2.0 cm
lesion diameter over 2.0 cm
Excision, benign lesion, except skin tag (unless listed elsewhere), trunk, arms or legs; lesion diameter 0.5 cm or less

11420 Excision, benign lesion, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less
11440
11600
11601
11602
11603
11604
11606
11620
11621
11622
11623
11624
11626
11640
11641
11642
11643
11644
11646
11740
11752
11762
14000
14001
14040
14041
14060
14061

Excision, other benign lesion (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or
less
Excision, malignant lesion, trunk, arms, or legs; lesion diameter 0.5 cm or less
lesion diameter 0.6 to 1.0 cm
lesion diameter 1.1 to 2.0 cm
lesion diameter 2.1 to 3.0 cm
lesion diameter 3.1 to 4.0 cm
lesion diameter over 4.0 cm
Excision, malignant lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less
lesion diameter 0.6 to 1.0 cm
lesion diameter 1.1 to 2.0 cm
lesion diameter 2.1 to 3.0 cm
lesion diameter 3.1 to 4.0 cm
lesion diameter over 4.0 cm
Excision, malignant lesion, face, ears, eyelids, nose, lips; lesion diameter 0.5 cm or less
lesion diameter 0.6 to 1.0 cm
lesion diameter 1.1 to 2.0 cm
lesion diameter 2.1 to 3.0 cm
lesion diameter 3.1 to 4.0 cm
lesion diameter over 4.0 cm
Evacuation of subungual hematoma
w/ amputation of tuft of distal phalanx
Reconstruction of nail bed w/ graft
Adjacent tissue transfer or rearrangement, trunk; defect 10 sq cm or less
defect 10.1 sq cm to 30.0 sq cm
Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; defect 10 sq
cm or less
defect 10.1 sq cm to 30.0 sq cm
Adjacent tissue transfer or rearrangement, eyelids, nose, ears and/or lips; defect 10 sq cm or less
defect 10.1 sq cm to 30.0 sq cm

1of22

RVU
10
10
10
10
10
10
15
10
15
24
30
35
15
24
30
35
24
30
35
40
10
10
12
15
15
15
15
15
15
20
20
20
20
20
20
20
20
20
20
20
20
10
25
25
80
80
80
100
100
100

ANNEX

CODE

DESCRIPTIVE TERMS

14350 Filleted finger or toe flap, including preparation of recipient site

Pinch graft, single or multiple, to cover small ulcer, tip or digit, or other minimal open area (except on face), up to defect size 2
15050
cm diameter
Split graft, trunk, scalp, arms, legs, hands, and/or feet (except multiple digits); 100 sq cm or less, or each one percent of body area
15100
of infants and children (except 15050)
Split graft, face, eyelids, mouth, neck, ears, orbits, genitalia, and/or multiple digits; 100 sq cm or less, or each one percent of body
15120
area of infants and children (except 15050)
15200 Full thickness graft, free, including direct closure of donor site, trunk; 20 sq cm or less
15220 Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less
Full thickness graft, free, including direct closure of donor site, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands,
15240
and/or feet; 20 sq cm or less
15572
scalp, arms, or legs
15574
forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands or feet
15580 Cross finger flap, including free graft to donor site
15650 Transfer, intermediate, of any pedicle flap (e.g., abdomen to wrist, "Walking" tube), any location

RVU
180
40
40
110
110
110
160
160
160
110
110

15732 Muscle, myocutaneous, or fasciocutaneous flap; head and neck (e.g., temporalis, masseter, sternocleidomastoid, levator scapulae)

310

15734
15736
15738
15740
15750
15756
15757
15758
15760
15770
15820
15822
15823
15842
15920
15931
15933
15934
15936
15941
15944
15946
15950
15951
15952
15953
15956
15958
16010
16035
16040

310
310
310
260
260
260
260
260
110
110
55
55
70
260
160
110
160
80
235
110
160
235
70
110
110
160
210
235
40
160
50

17000
17100
17260
17261
17262
17263

trunk
upper extremity
lower extremity
Flap; island pedicle
neurovascular pedicle
Free muscle flap w/ or w/o skin graft w/ microvascular anastomosis
Free skin flap w/ microvascular anastomosis
Free fascial flap w/ microvascular anastomosis
Graft; composite (e.g., full thickness of external ear or nasal ala), including primary closure, donor area
derma-fat-fascia
Blepharoplasty, lower eyelid
Blepharoplasty, upper eyelid;
with excessive skin weighting down lid
free muscle graft by microsurgical technique
Excision, coccygeal pressure ulcer, w/ coccygectomy; w/ primary suture
Excision, sacral pressure ulcer, w/ primary suture;
w/ ostectomy
Excision, sacral pressure ulcer, w/ skin flap closure;
Excision, sacral pressure ulcer, w/ muscle or myocutaneous flap closure;
w/ ostectomy (ischiectomy)
Excision, ischial pressure ulcer, w/ skin flap closure;
Excision, ischial pressure ulcer, w/ ostectomy, w/ muscle or myocutaneous flap closure
Excision, trochanteric pressure ulcer, w/ primary suture;
w/ ostectomy
Excision, trochanteric pressure ulcer, w/ skin flap closure;
w/ ostectomy
Excision, trochanteric pressure ulcer, w/ muscle or myocutaneous flap closure;
w/ ostectomy
Dressings and/or debridement, initial or subsequent
Escharotomy
Excision burn wound, w/o skin grafting, employing alloplastic dressing (e.g., synthetic mesh), any anatomic site
Destruction by any method, including laser, w/ or w/o surgical curettement, all benign facial lesions or premalignant lesions in
any location, or benign lesions other than cutaneous vascular proliferative lesions, including local anesthesia; any number of
lesions
Destruction by any method, including laser, of benign skin lesions other than cutaneous vascular proliferative lesions on any area
other than the face, including local anesthesia; any number of lesions
Destruction, malignant lesion, any method, trunk, arms or legs; lesion diameter 0.5 cm or less
lesion diameter 0.6 to 1.0 cm
Destruction, malignant lesion, any method, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm
lesion diameter 2.1 to 3.0 cm

2of22

30
30
20
20
20
20

ANNEX

CODE

DESCRIPTIVE TERMS

RVU

17264
lesion diameter 3.1 to 4.0 cm
17266
lesion diameter over 4.0 cm
17270 Destruction, malignant lesion, any method, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less
17271
lesion diameter 0.6 to 1.0 cm
17272 Destruction, malignant lesion, any method, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm
17273
lesion diameter 2.1 to 3.0 cm
17274
lesion diameter 3.1 to 4.0 cm
17276
lesion diameter over 4.0 cm

20
20
20
20
20
20
20
20

17281 Destruction, malignant lesion, any method, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm

25

17282
17283
17284
17286

25
25
25
25

17304
19000
19020
19100
19112
19120
19160
19180
19182
19200
19240
19260
19271
19272
21010
21025
21026
21029
21030
21031
21032
21034
21040
21041
21198
21300
21315
21325
21330
21335
21336
21337
21339
21340
21343

lesion diameter 1.1 to 2.0 cm

lesion diameter 2.1 to 3.0 cm
lesion diameter 3.1 to 4.0 cm
lesion diameter over 4.0 cm
Chemosurgery (Moh's micrographic technique), including removal of all gross tumor, surgical excision of tissue specimens,
mapping, color coding of specimens, microscopic examination of specimens by the surgeon, and complete histopathologic
preparation; first stage, fresh tissue technique, up to 5 specimens
Puncture aspiration of cyst of breast;
Mastotomy w/ exploration or drainage of abscess, deep
Biopsy of breast; needle core
Excision of lactiferous duct fistula
Excision of cyst, fibroadenoma, or other benign or malignant tumor aberrant breast tissue, duct lesion or nipple lesion (except
19140), male or female, one or more lesions
Mastectomy, partial;
Mastectomy, simple, complete
Mastectomy, subcutaneous
Mastectomy, radical, icnluding pectoral muscles, axillary lymph nodes
Mastectomy, modified radical, including axillary lymph nodes, w/ or w/o pectoralis minor muscle, but excluding pectoralis major
muscle
Excision of chest wall tumor including ribs
Excision of chest wall tumor involving ribs, w/ plastic reconstruction; w/o mediastinal lymphadenectomy
w/ mediastinal lymphadenectomy
Arthrotomy, temporomandibular joint
Excision of bone (e.g., for osteomyelitis or bone abscess); mandible
facial bone(s)
Removal by contouring of benign tumor of facial bone (e.g., fibrous dysplasia)
Excision of benign tumor or cyst of facial bone other than mandible
Excision of torus mandibularis
Excision of maxillary torus palatinus
Excision of malignant tumor of facial bone other than mandible
Excision of benign cyst or tumor of mandible; simple
complex
Osteotomy, mandible, segmental
Closed treatment of skull fracture w/o operation
Closed treatment of nasal bone fracture
Open treatment of nasal fracture; uncomplicated
complicated, w/ internal and/or external skeletal fixation
w/ concomitant open treatment of fractured septum
Open treatment of nasal septal fracture, w/ or w/o stabilization
Closed treatment of nasal septal fracture
w/ external fixation
Percutaneous treatment of nasoethmoid complex fracture, w/ splint, wire or headcap fixation, including repair of canthal
ligaments and/or the nasolacrimal apparatus
Open treatment of depressed frontal sinus fracture

30
10
50
10
40
30
80
100
60
200
200
300
400
450
50
100
100
100
100
100
100
150
100
110
200
60
60
80
80
80
80
60
100
110
110

21345 Closed treatment of nasomaxillary complex fracture (LeFort II type), w/ interdental wire fixation or fixation of denture or splint

140

21355 Percutaneous treatment of fracture of malar area, including zygomatic arch and malar tripod, w/ manipulation

110

3of22

ANNEX

CODE
21431
21480
21485
21501
21550
21555
21556
21557
22554
22556
22558
25574

DESCRIPTIVE TERMS
Closed treatment of craniofacial separation (LeFort III type) using interdental wire fixation of denture or splint
Closed treatment of temporomandibular dislocation; initial or subsequent
complicated (e.g., recurrent requiring intermaxillary fixation or splinting), initial or subsequent
Incision and drainage, deep abscess or hematoma, soft tissues of neck or thorax;
Biopsy, soft tissue of neck or thorax
Excision tumor, soft tissue of neck or thorax; subcutaneous
deep, subfascial, intramuscular
Radical resection of tumor (e.g., malignant neoplasm), soft tissue of neck or thorax
Arthrodesis, anterior interbody technique, including minimal diskectomy to prepare interspace (other than for decompression);
cervical below C2
thoracic
lumbar
Open treatment of radial AND ulnar shaft fractures, w/ internal or external fixation; of radius or ulna

RVU
80
50
120
20
20
30
50
200
350
300
300
190

26350 Flexor tendon repair or advancement, single, not in "no man's land", primary or secondary w/o free graft, each tendon

80

27590 Amputation, thigh, through femur, any level;

Open treatment of tibial shaft fracture (w/ or w/o fibular fracture) by intramedullary implant, w/ or w/o interlocking screws
27759
and/or cerclage
27880 Amputation, leg, through tibia and fibula;
30100 Biopsy, intranasal
30117 Excision or destruction, any method (including laser), intranasal lesion; internal approach
30130 Excision turbinate, partial or complete
30140 Submucous resection turbinate, partial or complete
30310 Removal foreign body, intranasal; requiring general anesthesia
30520 Septoplasty or submucous resection, w/ or w/o cartilage scoring, contouring or replacement w/ graft
30540 Repair choanal atresia; intranasal
30545
transpalatine
30560 Lysis intranasal synechia
30580 Repair fistula; oromaxillary (combine w/ 31030 if antrotomy is included)
30600
oronasal
30630 Repair nasal septal perforations
30801 Cauterization and/or ablation, mucosa of turbinates, unilateral or bilateral, any method, ; superficial
30802
intramural
30905 Control nasal hemorrhage, posterior, w/ posterior nasal packs and/or cauterization, any method; initial
30915 Ligation arteries; ethmoidal
30920
internal maxillary artery, transantral
30930 Fracture nasal turbinate(s), therapeutic
31000 Lavage by cannulation; maxillary sinus (antrum puncture or natural ostium)
31002
sphenoid sinus
31020 Sinusotomy, maxillary (antrotomy); intranasal
31030
radical (Caldwell-Luc) w/o removal of antrochoanal polyps
31032
radical (Caldwell-Luc) w/ removal of antrochoanal polyps
31040 Pterygomaxillary fossa surgery, any approach
31050 Sinusotomy, sphenoid, w/ or w/o biopsy;
31051
w/ mucosal stripping or removal of polyp(s)
31070 Sinusotomy frontal; external, simple (trephine operation)
31075
transorbital, unilateral (for mucocele or osteoma, Lynch type)
31080
obliterative w/o osteoplastic flap, brow incision (includes ablation)
31081
obliterative, w/o osteoplastic flap, coronal inicision (includes ablation)
31085
obliterative, w/ osteoplastic flap, coronal incision
31086
nonobliterative, w/ osteoplastic flap, brow incision
31087
nonobliterative, w/ osteoplastic flap, coronal incision
31090 Sinusotomy combined, three or more sinuses
31200 Ethmoidectomy; intranasal, anterior
31201
intranasal, total
31205
extranasal, total

200

4of22

180
200
20
50
75
75
30
75
75
100
40
80
80
80
50
50
30
80
80
50
25
30
50
80
80
150
150
150
80
80
80
80
150
150
150
150
80
80
80

ANNEX

CODE
31225
31230
31231
31233
31237
31238
31239
31240
31254
31255
31276
31287
31288
31300
31360
31365
31367
31368
31370
31375
31380
31382
31395
31400
31420
31530
31531
31535
31536
31540
31541
31560
31561
31570
31571
31575
31576
31577
31578
31579
31580
31582
31584
31586
31587
31595
31600
31601
31603
31605
31610
31611
31612
31613
31614

DESCRIPTIVE TERMS
Maxillectomy; w/o orbital exenteration
w/ orbital exenteration (en bloc)
Nasal endoscopy, diagnostic, unilateral or bilateral
Nasal/sinus endoscopy, diagnostic w/ maxillary sinusoscopy (via inferior meatus or canine fossa puncture)
Nasal/sinus endoscopy, surgical; w/ biopsy, polypectomy or debridement
w/ control of epistaxis
w/ dacrylocystorhinostomy
w/ concha bullosa resection
Nasal/sinus endoscopy, surgical; w/ ethmoidectomy, partial (anterior)
w/ ethmoidectomy, total (anterior and posterior)
Nasal/sinus endoscopy, surgical w/ frontal sinus exploration, w/ or w/o removal of tissue from frontal sinus
Nasal/sinus endoscopy, surgical, w/ sphenoidotomy
w/ removal of tissure from the sphenoid sinus
Laryngotomy (thyrotomy, laryngofissure); w/ removal of tumor or laryngocele, cordectomy
Laryngectomy; total, w/o radical neck dissection
total, w/ radical neck dissection
subtotal supraglottic, w/o radical neck dissection
subtotal supraglottic, w/ radical neck dissection
Partial laryngectomy (hemilaryngectomy); horizontal
laterovertical
anterovertical
antero-latero-vertical
Pharyngolaryngectomy, w/ radical neck dissection; w/ reconstruction
Arytenoidectomy or arytenoidopexy, external approach
Epiglottidectomy
Laryngoscopy, direct, operative, w/ foreign body removal;
w/ operating microscope
Laryngoscopy, direct, operative, w/ biopsy;
w/ operating microscope
Laryngoscopy, direct, operative, w/ excision of tumor and/or stripping of vocal cords or epiglottis;
w/ operating microscope
Laryngoscopy, direct, operative, w/ arytenoidectomy;
w/ operating microscope
Laryngoscopy, direct, w/ injection into vocal cord(s), therapeutic;
w/ operating microscope
Laryngoscopy, flexible fiberoptic; diagnostic
w/ biopsy
w/ removal of foreign body
w/ removal of lesion
Laryngoscopy, flexible or rigid fiberoptic, w/ stroboscopy
Laryngoplasty; for laryngeal web, two stage, w/ keel insertion and removal
for laryngeal stenosis, w/ graft or core mold, including tracheotomy
w/ open reduction of fracture
w/ closed manipulative reduction
Laryngoplasty, cricoid split
Section recurrent laryngeal nerve, therapeutic , unilateral
Tracheostomy, planned ;
under two years
Tracheostomy, emergency procedure; transtracheal
cricothyroid membrane
Tracheostomy, fenestration procedure with skin flaps
Construction of tracheoesophageal fistula and subsequent insertion of an alaryngeal speech prosthesis (e.g., voice button, BlomSinger prosthesis)
Tracheal puncture, percutaneous w/ transtracheal aspiration and/or injection
Tracheostoma revision; simple, w/o flap rotation
complex, w/ flap rotation

5of22

RVU
300
350
60
60
80
80
80
100
100
100
100
100
100
100
210
250
220
240
210
210
210
210
300
200
150
80
80
80
80
80
80
200
200
80
80
80
80
80
80
80
200
200
200
200
200
150
80
85
85
85
85
90
75
80
90

ANNEX

CODE
31615
31622
31625
31628
31629
31630
31631
31635
31640
31641
31645
31717
31750
31755
31770
31775
31780
31781
31785
31786
31800
31805
32002
32005
32020
32035
32036
33238
33974
36488
36810
36815
37184
37187
37204
37205
38230
38240
38300
38380
38381
38382
38500
38505
38510
38550
38555
38570
38571
38572
38700
38720

DESCRIPTIVE TERMS
Tracheobronchoscopy through established tracheostomy incision
Bronchoscopy; diagnostic, (flexible or rigid), w/ or w/o cell washing or brushing
w/ biopsy
w/ transbronchial lung biopsy, w/ or w/o fluoroscopic guidance
w/ transbronchial needle aspiration biopsy
w/ tracheal or bronchial dilation or closed reduction of fracture
w/ tracheal dilation and placement of tracheal stent
w/ removal of foreign body
w/ excision of tumor
w/ destruction of tumor or relief of stenosis by any method other than excision (e.g., laser)
w/ therapeutic aspiration of tracheobronchial tree, (e.g., drainage of lung abscess)
Catheterization w/ bronchial brush biopsy
Tracheoplasty; cervical
tracheopharyngeal fistulization, each stage
Bronchoplasty; graft repair
excision stenosis and anastomosis
Excision tracheal stenosis and anastomosis; cervical
cervicothoracic
Excision of tracheal tumor or carcinoma; cervical
thoracic
Suture of tracheal wound or injury; cervical
intrathoracic
Thoracentesis w/ insertion of tube w/ or w/o water seal (e.g., for pneumothorax)
Chemical pleurodesis (e.g., for recurrent or persistent pneumothorax)
Tube thoracostomy w/ or w/o water seal (e.g., for abscess, hemothorax, empyema)
Thoracostomy; w/ rib resection for empyema
w/ open flap drainage for empyema
Removal of permanent transvenous electrode(s) by thoracotomy
Removal of intra-aortic balloon assist device from the ascending aorta, including repair of the ascending aorta, w/ or w/o graft
Placement of central venous catheter (subclavian, jugular, or other vein) (e.g., for central venous pressure, hyperalimentation,
hemodialysis, or chemotherapy); percutaneous or cutdown
arteriovenous, external (Scribner type)
arteriovenous, external revision, or closure
Primary percutaneous transluminal mechanical thrombectomy, non-coronary, arterial or arterial bypass graft including
fluoroscopic guidance and intraprocedural pharmacological thrombolytic injections; one or more vessels
Percutaneous transluminal mechanical thrombectomy, veins, including intraprocedural pharmacological thrombolytic injections
and fluoroscopic guidance; one or more vessels
Transcatheter occlusion or embolization (e.g., for tumor destruction, to achieve hemostasis, to occlude a vascular malformation),
percutaneous, any method, non-central nervous system, non-head or neck
Transcatheter placement of an intravascular stent(s), (non-coronary vessel), percutaneous; initial vessel
Bone marrow harvesting for transplantation
Bone marrow or peripheral blood derived peripheral stem cell transplantation
Drainage of lymph node abscess or lymphadenitis
Suture and/or ligation of thoracic duct; cervical approach
thoracic approach
abdominal approach
Biopsy or excision or lymph node(s); superficial
by needle, superficial (e.g., cervical, inguinal, axillary)
deep cervical node(s)
Excision of cystic hygroma, axillary or cervical; w/o deep neurovascular dissection
w/ deep neurovascular dissection
Laparoscopy, surgical; with retroperitoneal lymph node sampling (biopsy), single or multiple
with bilateral total pelvic lymphadenectomy
with bilateral total pelvic lymphadenectomy and peri-aortic lymph node sampling (biopsy), single or multiple
Suprahyoid lymphadenectomy
Cervical lymphadenectomy (complete)

6of22

RVU
80
65
65
65
65
100
100
100
200
200
150
150
250
250
400
400
300
350
250
400
150
250
60
60
95
80
105
200
200
50
50
50
300
300
300
300
100
250
40
200
200
200
20
20
40
250
300
180
200
450
180
200

ANNEX

CODE
38724
38740
38745
38746
39000
40490
40700
40701
40702
40720
40761
40800
40808
40810
40830
40831
40840
40842
40844
41000
41005
41006
41007
41008
41015
41016
41017
41100
41105
41108
41110
41115
41140
41250
41251
41252
41500
41510
41520
41800
41805
41820
41821
41822
41823
41828
41830
41850
41872
41874
42000
42300
42310
42320
42400
42409

DESCRIPTIVE TERMS
Cervical lymphadenectomy (modified radical neck dissection)
Axillary lymphadenectomy; superficial
complete
Thoracic lymphadenectomy, regional, including mediastinal and peritracheal nodes
Mediastinotomy with exploration, drainage, removal of foreign body, or biopsy; cervical approach
Biopsy of lip
Plastic repair of cleft lip/nasal deformity; primary, partial or complete, unilateral
primary bilateral, one stage procedure
primary bilateral, one of two stages
secondary, by recreation of defect and reclosure
w/ cross lip pedicle flap (Abbe-Estlander type), including sectioning and inserting of pedicle
Drainage of abscess, cyst, hematoma, vestibule of mouth
Biopsy, vestibule of mouth
Excision of lesion of mucosa and submucosa, vestibule of mouth
Closure of laceration, vestibule of mouth; 2.5 cm or less
over 2.5 cm or complex
Vestibuloplasty; anterior
posterior, unilateral
entire arch
Intraoral incision and drainage of abscess, cyst, or hematoma of tongue or floor of mouth; lingual
sublingual, superficial
sublingual, deep, supramylohyoid
submental space
submandibular space
Extraoral incision and drainage of abscess,cyst,or hematoma of floor of mouth;sublingual
submental
submandibular
Biopsy of tongue; anterior two-thirds
posterior one-third
Biopsy of floor of mouth
Excision of lesion of tongue w/o closure
Excision of lingual frenum (frenectomy)
Glossectomy; complete or total, w/ or w/o tracheostomy, w/o radical neck dissection
Repair of laceration 2.5 cm or less; floor of mouth and/or anterior two-thirds of tongue
posterior one-third of tongue
Repair of laceration of tongue, floor of mouth, over 2.6 cm or complex
Frenoplasty (surgical revision of frenum, eg, w/ Z-plasty)
Suture of tongue to lip for micrognathia (Douglas type procedure)
Frenoplasty (surgical revision of frenum, eg, w/ Z-plasty)
Drainage of abscess, cyst, hematoma from dentoalveolar structures
Removal of embedded foreign body from dentoalveolar structures; soft tissues
Gingivectomy, excision gingiva
Operculectomy, excision pericoronal tissues
Excision of fibrous tuberosities, dentoalveolar structures
Excision of osseous tuberosities, dentoalveolar structures
Excision of hyperplastic alveolar mucosa
Alveolectomy, including curettage of osteitis or sequestrectomy
Destruction of lesion (except excision), dentoalveolar structures
Gingivoplasty
Alveoloplasty
Drainage of abscess of palate, uvula
Drainage of abscess; parotid
Drainage of abscess; submaxillary or sublingual, intraoral
submaxillary, external
Biopsy of salivary gland; needle
Marsupialization of sublingual salivary cyst (ranula)

7of22

RVU
200
150
200
250
100
15
250
250
200
200
250
20
20
20
20
20
80
80
100
20
20
20
20
20
20
20
20
15
15
15
25
25
250
50
50
50
50
50
50
20
10
30
30
30
30
30
40
40
100
100
30
20
20
20
15
25

ANNEX

CODE
42410
42415
42425
42440
42450
42500
42505
42507
42508
42509
42510
42600
42665
42700
42720
42725
42800
42802
42804
42806
42808
42809
42810
42820
42825
42830
42835
43200
43202
43204
43205
43215
43216
43217
43219
43220
43226
43227
43228
43234
43235
43239
43241
43243
43244
43245
43246
43247
43248
43249
43250
43251
43255

DESCRIPTIVE TERMS
Excision of parotid tumor or parotid gland; lateral lobe, w/o nerve dissection
lateral lobe, w/ dissection and preservation of facial nerve
total, en bloc removal w/ sacrifice of facial nerve
Excision of submandibular (submaxillary) gland
Excision of sublingual gland
Plastic repair of salivary duct, sialodochoplasty; primary or simple
secondary or complicated
Parotid duct diversion, bilateral (Wilke type procedure);
w/ excision of one submandibular gland
w/ excision of both submandibular glands
w/ ligation of both submandibular (Wharton's) ducts
Closure salivary fistula
Ligation salivary duct, intraoral
Incision and drainage abscess; peritonsillar
retropharyngeal or parapharyngeal, intraoral approach
retropharyngeal or parapharyngeal, external approach
Biopsy; oropharynx
hypopharynx
nasopharynx, visible lesion, simple
nasopharynx, survey for unknown primary lesion
Excision or destruction of lesion of pharynx, any method
Removal of foreign body from pharynx
Excision branchial cleft cyst or vestige, confined to skin and subcutaneous tissues
Tonsillectomy and adenoidectomy
Tonsillectomy, primary or secondary
Adenoidectomy, primary
Adenoidectomy, secondary
Esophagoscopy, rigid or flexible; diagnostic, w/ or w/o collection of specimen(s) by brushing or washing
w/ biopsy, single or multiple
w/ injection sclerosis of esophageal varices
w/ band ligation of esophageal varices
w/ removal of foreign body
w/ removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery
w/ removal of tumor(s), polyp(s), or other lesion(s) by snare technique
w/ insertion of plastic tube or stent
w/ balloon dilation (less than 30 mm diameter)
w/ insertion of guide wire followed by dilation over guide wire
w/ control of bleeding, any method
w/ ablation of tumor(s) polyp(s), or other lesion(s), not amenable to removal by hot biopsy forceps, bipolar cautery or snare
technique
Upper gastrointestinal endoscopy, simple primary examination ( e.g. w/ small diameter flexible endoscope)
Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate;
diagnostic, w/ or w/o collection of specimen(s) by brushing or washing
w/ biopsy, single or multiple
w/ transendoscopic tube or catheter placement
w/ injection sclerosis of esophageal and/or gastric varices
w/ band ligation of esophageal and/or gastric varices
w/ dilation of gastric outlet for obstruction, any method
w/ directed placement of percutaneous gastrostomy tube
w/ removal or foreign body
w/ insertion of guide wire followed by dilation of esophagus over guide wire
w/ ballon dilation of esophagus (less than 30 mm diameter)
w/ removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery
w/ removal of tumor(s), polyp(s), or other lesion(s) by snare technique
w/ control of bleeding, any method

8of22

RVU
150
200
200
100
100
100
100
100
100
100
100
40
40
40
40
40
30
30
30
30
30
30
100
100
100
100
100
60
60
90
90
90
70
80
100
100
100
90
100
60
60
60
80
90
90
100
100
90
100
100
70
80
90

ANNEX

CODE
43258
43259
43260
43261
43262
43263
43264
43265
43267
43268
43269
43271
43272
43300
43500
43501
43502
43510
43520
43600
43605
43610
43611
43620
43621
43622
43631
43632
43633
43634
43638
43639
43640
43641
43800
43810
43820
43825
43830
43831
43832
43840
43842
43843
43846
43847
43848
43850
43855
43860
43865

DESCRIPTIVE TERMS
w/ ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare
technique
w/ endoscopic ultrasound examination
Endoscopic retrograde cholangiopancreatography (ERCP); diagnostic, w/ or w/o collection of specimen(s) by brushing or
washing
w/ biopsy, single or multiple
w/ sphincterotomy/papillotomy
w/ pressure measurement of sphincter of Oddi (pancreatic duct or common bile duct)
w/ endoscopic retrograde removal of stone(s) from biliary and/or pancreatic ducts
w/ endoscopic retrograde destruction, lithotripsy of stone(s), any method
w/ endoscopic retrograde insertion of nasobiliary or nasopancreatic drainage tube
w/ endoscopic retrograde insertion of tube or stent into bile or pancreatic duct
w/ endoscopic retrograde removal of foreign body and/or change of tube or stent
w/ endoscopic retrograde balloon dilation of ampulla, biliary and/or pancreatic duct(s)
w/ ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare
technique
Esophagoplasty, (plastic repair or reconstruction), cervical approach; w/o repair of tracheoesophageal fistula
Gastrotomy; w/ exploration or foreign body removal
w/ suture repair of bleeding ulcer
w/ suture repair of pre-existing esophagogastric laceration (e.g., Mallory-Weiss)
w/ esophageal dilation and insertion of permanent intraluminal tube (e.g., Celestin or Mousseaux-Barbin)
Pyloromyotomy, cutting of pyloric muscle (Fredet-Ramstedt type operation)
Biopsy of stomach; by capsule, tube, peroral (one or more specimens)
by laparotomy
Excision, local; ulcer or benign tumor of stomach
malignant tumor of stomach
Gastrectomy, total; w/ esophagoenterostomy
w/ Roux-en-Y reconstruction
w/ formation of intestinal pouch, any type
Gastrectomy, partial, distal; w/ gastroduodenostomy
w/ gastrojejunostomy
w/ Roux-en-Y reconstruction
w/ formation of intestinal pouch
Gastrectomy, partial, proximal, thoracic or abdominal approach including esophagogastrostomy, w/ vagotomy;
w/ pyloroplasty or pyloromyotomy
Vagotomy including pyloroplasty, w/ or w/o gastrostomy; truncal or selective
parietal cell (highly selective)
Pyloroplasty
Gastroduodenostomy
Gastrojejunostomy; w/o vagotomy
w/ vagotomy, any type
Gastrostomy, temporary (tube, rubber or plastic) ;
neonatal, for feeding
Gastrostomy, permanent, w/ construction of gastric tube
Gastrorrhaphy, suture of perforated duodenal or gastric ulcer, wound, or injury
Gastric restrictive procedure, w/o gastric bypass, for morbid obesity; vertical-banded gastroplasty
other than vertical-banded gastroplasty
Gastric restrictive procedure, w/ gastric bypass for morbid obesity; w/ short limb (less than 100 cm) Roux-en-Y
gastroenterostomy
w/ small bowel reconstruction to limit absorption
Revision of gastric restrictive procedure for morbid obesity
Revision of gastroduodenal anastomosis (gastroduodenostomy) w/ reconstruction; w/o vagotomy
w/ vagotomy
Revision of gastrojejunal anastomosis (gastrojejunostomy) w/ reconstruction, w/ or w/o partial gastrectomy or bowel resection;
w/o vagotomy
w/ vagotomy

9of22

RVU
100
90
120
120
130
130
150
160
140
140
140
150
150
200
200
230
230
230
230
40
200
230
230
500
550
550
400
400
500
500
500
550
250
300
250
500
300
350
250
250
250
300
400
450
450
450
450
450
500
450
500

ANNEX

CODE
43870
43880
44005
44010
44020
44021
44025
44050
44055

DESCRIPTIVE TERMS
Closure of gastrostomy, surgical
Closure of gastrocolic fistula
Enterolysis (freeing of intestinal adhesion)
Duodenotomy, for exploration, biopsy(s), or foreign body removal
Enterotomy, small bowel, other than duodenum; for exploration, biopsy(s), or foreign body removal
for decompression (e.g., Baker tube)
Colotomy, for exploration, biopsy(s), or foreign body removal
Reduction of volvulus, intussusception, internal hernia, by laparotomy
Correction of malrotation by lysis of duodenal bands and/or reduction of midgut volvulus (e.g., Ladd procedure)

44100 Biopsy of intestine by capsule, tube, peroral (one or more specimens)

Excision of one or more lessions of small or large bowel not requiring anastomosis, exteriorization, or fistulization; single
44110
enterotomy
44111
multiple enterotomies
44120 Enterectomy, resection of small intestine; single resection and anastomosis
44125
w/ enterostomy
44130 Enteroenterostomy, anastomosis of intestine, w/ or w/o cutaneous enterostomy
44140 Colectomy, partial; w/ anastomosis
44141
w/ skin level cecostomy or colostomy
44143
w/ end colostomy and closure of distal segment (Hartmann type procedure)
44144
w/ resection, w/ colostomy or ileostomy and creation of mucofistula
44145
w/ coloproctostomy (low pelvic anastomosis)
44146
w/ coloproctostomy (low pelvic anastomosis), w/ colostomy
44147
abdominal and transanal approach
44150 Colectomy, total, abdominal, w/o proctectomy; w/ ileostomy or ileoproctostomy
44151
w/ continent ileostomy
44152
w/ rectal mucosectomy, ileoanal anastomosis, w/ or w/o loop ileostomy
44153
w/ rectal mucosectomy, ileoanal anastomosis, creation of ileal reservior (S or J), w/ or w/o loop ileostomy
44155 Colectomy, total, abdominal, w/ proctectomy; w/ ileostomy
44156
w/ continent ileostomy
44160 Colectomy w/ removal of terminal ileum and ileocolostomy
44227 Laparoscopy, surgical; closure of enterostomy, large or small intestine, with resection and anastomosis
44300 Enterostomy or cecostomy, tube (e.g., for decompression or feeding)
44310 Ileostomy or jejunostomy, non- tube
44312 Revision of ileostomy; simple (release of superficial scar)
44314
complicated (reconstruction in-depth)
44316 Continent ileostomy (Koch procedure)
44320 Colostomy or skin level cecostomy;
44322
w/ multiple biopsies (e.g., for Hirschsprung disease)
44340 Revision of colostomy; simple (release of superficial scar)
44345
complicated (reconstruction in - depth )
44346
w/ repair of paracolostomy hernia
Small intestinal endoscopy, enteroscopy, beyond second portion of duodenum, not including ileum; diagnostic, w/ or w/o
44360
collection of specimen(s) by brushing or washing
44361
w/ biopsy, single or multiple
44363
w/ removal of foreign body
44364
w/ removal of tumor(s), polyp(s), or other lesions(s) by snare technique
44365
w/ removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery
44366
w/ control of bleeding, any method
w/ ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare
44369
tenchnique
44372
w/ placement of percutaneous jejunostomy tube
44373
w/ conversion of percutaneous gastrostomy tube to percutaneous jejunostomy tube
Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, including ileum; diagnostic, w/ or w/o collection
44376
of specimen(s) by brushing or washing
44377
w/ biopsy, single or multiple
44378
w/ control of bleeding, any method

10of22

RVU
300
450
450
350
250
250
250
350
400
100
250
300
300
300
350
450
450
450
450
420
450
500
500
500
550
550
550
550
550
150
100
130
150
130
200
150
200
150
200
200
90
90
100
100
100
100
110
110
110
100
100
110

ANNEX

CODE

DESCRIPTIVE TERMS

44380 Ileoscopy, through stoma; diagnostic, w/ or w/o collection of specimen(s) by brushing or washing
44382
w/ biopsy, single or multiple
Endoscopic evaluation of small intestinal (abdominal or pelvic) pouch; diagnostic, w/ or w/o collection of specimen(s) by
44385
brushing or washing
44386
w/ biopsy, single or multiple
44388 Colonoscopy through stoma; diagnostic, w/ or w/o collection of specimen(s) by brushing or washing
44389
w/ biopsy, single or multiple
44390
w/ removal of foreign body
44391
w/ control of bleeding, any method
44392
w/ removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery
w/ ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar caurtery or snare
44393
technique
44394
w/ removal of tumor(s), polyp(s), or other lesion(s) by snare technique

RVU
90
90
90
90
90
90
100
100
100
110
110

44602 Suture of small intestine (enterorrhaphy) for perforated ulcer, diverticulum, wound, injury or rupture; single perforation

250

44603

250

44604
44605
44615
44620
44625
44970
45000
45005
45020
45100
45108
45150
45190
45300
45303
45305
45307
45309
45315
45317
45320
45321
45330
45331
45332
45333
45334
45337
45338
45339
45355
45378
45379
45380
45382
45383

multiple perforation
Suture of large intestine (colorrhaphy) for perforated ulcer, diverticulum, wound, injury or rupture (single or multiple
perforations); w/o colostomy
w/ colostomy
Intestinal stricturoplasty (enterotomy and enterorrhaphy) w/ or w/o dilation, for intestinal obstruction
Closure of enterostomy, large or small intestine;
w/ resection and anastomosis
Laparoscopy, surgical; appendectomy
Transrectal drainage of pelvic abscess
Incision and drainage of submucosal abscess, rectum
Incision and drainage of deep supralevator, pelvirectal, or retrorectal abscess
Biopsy of anorectal wall, anal approach (e.g., congenital megacolon)
Anorectal myomectomy
Division of stricture of rectum
Destruction of rectal tumor, any method (e.g., electrodesiccation) transanal approach
Proctosigmoidoscopy, rigid; diagnostic, w/ or w/o collection of specimen(s) by brushing or washing
w/ dilation, any method
w/ biopsy, single or multiple
w/ removal of foreign body
w/ removal of single tumor, polyp, or other lesion by snare technique
w/ removal of multiple tumors, polyps or other lesions by hot biopsy forceps, bipolar cautery or snare technique
w/ control of bleeding, any method
w/ ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare
technique (e.g., laser)
w/ decompression of volvulus
Sigmoidoscopy, flexible; diagnostic, w/ or w/o collection of specimen(s) by brushing or washing
w/ biopsy, single or multiple
w/ removal of foreign body
w/ removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery
w/ control of bleeding, any method
w/ decompression of volvulus, any method
w/ removal of tumor(s), polyp(s), or other lesion(s) by snare technique
w/ ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare
technique
Colonoscopy, rigid or flexible, transabdominal via colotomy, single or multiple
Colonoscopy, flexible, proximal to splenic flexure; diagnostic, w/ or w/o collection of specimen(s) by brushing or washing, w/
or w/o colon decompression
w/ removal of foreign body
w/ biopsy, single or multiple
w/ control of bleeding, any method
w/ ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare
technique

11of22

250
250
250
200
200
120
200
100
200
150
200
80
100
30
50
30
40
50
60
60
60
60
40
40
50
50
60
80
60
70
60
80
80
80
100
90

ANNEX

CODE
45384
45385
45905
45910
45915
46040
46221
46230
46250
46255
46257
46258
46260
46261
46262
46270
46275
46280
46288
46320
46600
46610
46611
46612
46614
46615
46705
46715
46716
46730
46735
46740
46742
46744

DESCRIPTIVE TERMS
w/ removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery
w/ removal of tumor(s), polyp(s), or other lesion(s) by snare technique
Dilation of anal sphincter under anesthesia other than local
Dilation of rectal stricture under anesthesia other than local
Removal of fecal impaction or foreign body under anesthesia
Incision and drainage of ischiorectal and/or perirectal abscess
Hemorrhoidectomy, by simple ligature (e.g., rubber band)
Excision of external hemorrhoid tags and/or multiple papillae
Hemorrhoidectomy, external, complete
Hemorrhoidectomy, internal and external, simple;
w/ fissurectomy
w/ fistulectomy, w/ or w/o fissurectomy
Hemorrhoidectomy, internal and external, complex or extensive;
w/ fissurectomy
w/ fistulectomy, w/ or w/o fissurectomy
Surgical treatment of anal fistula (fistulectomy/fistulotomy); subcutaneous
submuscular
complex or multiple, w/ or w/o placement of seton
Closure of anal fistula w/ rectal advancement flap
Enucleation or excision of external thrombotic hemorrhoid
Anoscopy; diagnostic, w/ or w/o collection of specimen(s) by brushing or washing
w/ removal of single tumor, polyp, or other lesion by hot biopsy forceps or bipolar cautery
w/ removal of single tumor, polyp or other lesion by snare technique
w/ removal of multiple tumor, polyps, or other lesions by hot biopsy forceps, bipolar cautery or snare technique
w/ control of bleeding, any method
w/ ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare
technique
Anoplasty, plastic operation for stricture; infant
Repair of low imperforate anus; w/ anoperineal fistula ("cut-back" procedure)
w/ transportation of anoperineal or anovestibular fistula
Repair of high imperforate anus w/o fistula; perineal or sacroperineal approach
combined transabdominal and sacroperineal approaches
Repair of high imperforate anus w/ rectourethral or rectovaginal fistula; perineal or sacroperineal approach
combined transabdominal and sacroperineal approaches
Repair of cloacal anomaly by anorectovaginoplasty and urethroplasty, sacroperineal approach

RVU
90
100
40
40
40
40
80
80
80
80
80
80
80
80
80
80
80
80
100
80
20
30
40
40
30
50
150
150
250
250
300
200
350
450

46746 Repair of cloacal anomaly by anorectovaginoplasty and urethroplasty, combined abdominal and sacroperineal approach;

500

46748
46751
47100
47135
47136
47370
47371
47490
47510
47511

500
150
100
400
400
100
100
200
200
200

47552
47553
47554
47555
47556
47562
47600
47630

w/ vaginal lengthening by intestinal graft or pedicle flaps

Sphincteroplasty, anal, for incontinence or prolapse; child
Biopsy of liver, wedge
Liver allotransplantation; orthotopic, partial or whole, from cadaver or living donor, any age
heterotopic, partial or whole, from cadaver or living donor, any age
Laparoscopy, surgical, ablation of one or more liver tumor(s); radiofrequency
cryosurgical
Percutaneous cholecystostomy
Introduction of percutaneous transhepatic catheter for biliary drainage
Introduction of percutaneous transhepatic stent for internal and external biliary drainage
Biliary endoscopy, percutaneous via T- tube or other tract; diagnostic, w/ or w/o collection of specimen(s) by brushing and/or
washing
w/ biopsy, single or multiple
w/ removal of stone(s)
w/ dilation of biliary duct stricture(s) w/o stent
w/ dilation of biliary duct stricture(s) w/ stent
Laparoscopy, surgical; cholecystectomy (any method)
Cholecystectomy;
Biliary duct stone extraction, percutaneous via T-tube tract, basket, or snare (e.g., Burhenne technique)

12of22

150
150
150
150
150
200
200
150

ANNEX

CODE

DESCRIPTIVE TERMS

RVU

48005
48100
48140
48145
48146

Resection or debridement of pancreas and peripancreatic tissue for acute necrotizing pancreatitis
Biopsy of pancreas, open, any method (e.g., fine needle aspiration, needle core biopsy, wedge biopsy)
Pancreatectomy, distal subtotal, w/ or w/o splenectomy; w/o pancreaticojejunostomy
w/ pancreaticojejunostomy
Pancreatectomy, distal, near-total w/ preservation of duodenum (Child-type procedure)
Pancreatectomy, proximal subtotal w/ near total duodenectomy, choledochoenterostomy and duodenojejunostomy (pylorussparing, Whipple-type procedure); w/ pancreatojejunostomy
w/o pancreatojejunostomy
Pancreatectomy, total
Pancreatectomy, total or subtotal, w/ autologous transplantation of pancreas or pancreatic islets
Pancreaticojejunostomy, side-to-side anastomosis (Puestow-type operation)
Internal anastomosis of pacreatic cyst to gastrointestinal tract; direct
Pancreatorrhaphy for trauma
Transplantation of pancreatic allograft
Removal of transplanted pancreatic allograft
Laparoscopy, surgical; with biopsy (single or multiple)
with aspiration of cavity or cyst (single or multiple)
Repair initial inguinal hernia, under age 6 months, w/ or w/o hydrocelectomy; reducible
Repair initial inguinal hernia, age 6 months to under 5 years, w/ or w/o hydrocelectomy; reducible
Repair initial inguinal hernia, age 5 years or over; reducible
Nephrolithotomy; removal of calculus
secondary surgical operation for calculus
removal of large staghorn calculus filling renal pelvis and calyces (including anatrophic pyelolithotomy)
Percutaneous nephrostolithotomy or pyelostolithotomy, w/ or w/o dilation, endoscopy, lithotripsy, stenting, or basket extraction;
up to 2 cm
w/ removal of calculus (pyelolithotomy, pelviolithotomy, including coagulum pyelolithotomy)
complicated (e.g., secondary operation, congenital kidney abnormality)
Nephrectomy, including partial ureterectomy, any approach including rib resection;
complicated because of previous surgery on same kidney
radical, w/ regional lymphadenectomy and/or vena caval thrombectomy
Nephrectomy, partial
Excision or unroofing of cyst(s) of kidney
Excision of perinephric cyst
Donor nephrectomy, w/ preparation and maintenance of allograft; from living donor
Renal allotransplantation, implantation of graft; excluding donor and recipient nephrectomy
w/ recipient nephrectomy
Removal of transplanted renal allograft
Renal autotransplantation, reimplantation of kidney
Instillation of therapeutic agent into renal pelvis and/or ureter through established nephrostomy, pyelostomy or ureterostomy
tube
Introduction of intracatheter or catheter into renal pelvis for drainage and/or injection, percutaneous

300
80
300
350
350

48153
48154
48155
48160
48180
48520
48545
48554
48556
49321
49322
49495
49500
49505
50060
50065
50075
50080
50130
50135
50220
50225
50230
50240
50280
50290
50320
50360
50365
50370
50380
50391
50392

50393 Introduction of ureteral catheter or stent into ureter through renal pelvis for drainage and/or injection, percutaneous
50400
50405
50541
50542
50543
50610
50620
50630
50650
50700
50715
50760

Pyeloplasty (Foley Y-pyeloplasty), plastic operation on renal pelvis, w/ or w/o plastic operation on ureter, nephropexy,
nephrostomy, pyelostomy, or ureteral splinting; simple
complicated (congenital kidney abnormality, secondary pyeloplasty, solitary kidney, calycoplasty)
Laparoscopy, surgical; ablation of renal cysts
ablation of renal mass lesion(s)
partial nephrectomy
Ureterolithotomy; upper one-third of ureter
middle one-third of ureter
lower one-third of ureter
Ureterectomy, w/ bladder cuff
Ureteroplasty, plastic operation on ureter (e.g., stricture)
Ureterolysis, w/ or w/o repositioning of ureter for retroperitoneal fibrosis
Ureteroureterostomy

13of22

500
450
500
500
400
300
350
200
150
50
80
80
80
80
180
200
250
200
150
170
180
200
200
180
120
120
180
300
480
200
350
50
50
50
200
220
60
50
200
130
120
130
130
130
130
130

ANNEX

CODE

DESCRIPTIVE TERMS

RVU

50780
50940
51040
51050
51060
51065
51500
51600
51720
51940
52000

Ureteroneocystostomy; anastomosis of single ureter to bladder

Deligation of ureter
Cystostomy, cystotomy w/ drainage
Cystolithotomy, cystotomy w/ removal of calculus, w/o vesical neck resection
Transvesical ureterolithotomy
Cystotomy, w/ stone basket extraction and/or ultrasonic or electrohydraulic fragmentation of ureteral calculus
Excision of urachal cyst or sinus, w/ or w/o umbilical hernia repair
Injection procedure for cystography or voiding urethrocystography
Bladder instillation of anticarcinogenic agent
Closure of bladder exstrophy
Cystourethroscopy
Cystourethroscopy, w/ ureteral catheterization, w/ or w/o irrigation, instillation, or ureteropyelography, exclusive of radiologic
service;
Cystourethroscopy, w/ biopsy
Cystourethroscopy, w/ fulguration (including cryosurgery or laser surgery) of trigone, bladder neck, prostatic fossa, urethra, or
periurethral glands
Cystourethroscopy, w/ fulguration (including cryosurgery or laser surgery) or treatment of MINOR (less than 0.5 cm) lesion(s) w/
or w/o biopsy
Cystourethroscopy, w/ fulguration (including cryosurgery or laser surgery) and/or resection of; SMALL bladder tumor(s) (0.5 cm
to 2.0 cm)
MEDIUM bladder tumor(s) (2.0 to 5.0 cm)
LARGE bladder tumor(s)
Cystourethroscopy, w/ internal urethrotomy; female
male
Cystourethroscopy w/ direct vision internal urethrotomy
Cystourethroscopy, w/ removal of foreign body, calculus, or ureteral stent from urethra or bladder
Litholapaxy: crushing or fragmentation of calculus by any means in bladder and removal of fragments; simple or small (less than
2.5 cm)
complicated or large (over 2.5 cm)
Cystourethroscopy (including ureteral catheterization); w/ removal of ureteral calculus
w/ fragmentation of ureteral calculus (e.g., ultrasonic or electro-hydraulic technique)
Cystourethroscopy, w/ insertion of indwelling ureteral stent (e.g., Gibbons or double-J type)
Cystourethroscopy, w/ ureteroscopy and/or pyeloscopy (includes dilation of the ureter and/or pyeloureteral junction by any
method);
Cystourethroscopy w/ incision, fulguration, or resection of congenital posterior urethral valves, or congenital obstructive
hypertrophic mucosal folds
Transurethral incision of prostate
Transurethral resection of bladder neck
Transurethral electrosurgical resection of prostate, including control of postoperative bleeding, complete (vasectomy, meatomy,
cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included)
Transurethral resection; of residual obstructive tissue after 90 days postoperative
of regrowth of obstructive tissue longer than one year postoperative
of postoperative bladder neck contracture
Transurethral drainage of prostatic abscess
Dilation of urethral stricture by passage of sound or urethral dilator, male
Dilation of urethral stricture or vesical neck, male, general or conduction (spinal) anesthesia
Dilation of female urethra, general or conduction (spinal) anesthesia
Plastic operation of penis for straightening of chordee (e.g., hypospadias), w/ or w/o mobilization of urethra
Plastic operation on penis for correction of chordee or for first stage hypospadias repair w/ or w/o transplantation of prepuce
and/or skin flaps
Biopsy of testis, incisional
Orchiectomy, simple (including subcapsular), w/ or w/o testicular prosthesis, scrotal or inguinal approach
Orchiectomy, radical, for tumor; inguinal approach
w/ abdominal exploration
Exploration for undescended testis (inguinal or scrotal area)
Exploration for undescended testis w/ abdominal exploration
Reduction of torsion of testis, surgical, w/ or w/o fixation of contralateral testis

180
130
50
85
130
130
200
30
30
200
40

52005
52204
52214
52224
52234
52235
52240
52270
52275
52276
52310
52317
52318
52320
52325
52332
52335
52340
52450
52500
52601
52620
52630
52640
52700
53600
53605
53665
54300
54304
54505
54520
54530
54535
54550
54560
54600

14of22

50
60
70
70
120
135
150
75
75
85
60
100
110
70
100
60
80
110
150
150
250
120
250
120
100
20
20
20
50
90
20
60
65
85
60
85
65

ANNEX

CODE
54640
54650
54670
54820
54840
55040
55041
55060
55500
55530
55535
55540
55550
55700
55801
55810
55812
55815
55821
55840
55842
55845
55859
55866
56405
56420
56440
56441
56501
56605
56620
56625
56630
56700
56720
56740
57000
57061
57100
57120
57130
57135
57220
57230
57250
57260
57265
57300
57415
57452
57454
57522
57720

DESCRIPTIVE TERMS
Orchiopexy, inguinal approach, w/ or w/o hernia repair
Orchiopexy, abdominal approach, for intra-abdominal testis (e.g., Fowler-Stephens)
Suture or repair of testicular injury
Exploration of epididymis, w/ or w/o biopsy
Excision of spermatocele, w/ or w/o epididymectomy
Excision of hydrocele; unilateral
bilateral
Repair of tunica vaginalis hydrocele (Bottle type)
Excision of hydrocele of spermatic cord, unilateral
Excision of varicocele or ligation of spermatic veins for varicocele;
abdominal approach
w/ hernia repair
Laparoscopy, surgical; with ligation of spermatic veins for varicocele
Biopsy, prostate; needle or punch, single or multiple, any approach
Prostatectomy, perineal, subtotal (including control of postoperative bleeding, vasectomy, meatotomy, urethral calibration and/or
dilation, and internal urethrotomy)
Prostatectomy, perineal radical;
w/ lymph node biopsy(s) (limited pelvic lymphadenectomy)
w/ bilateral pelvic lymphadenectomy, including external iliac, hypogastric and obturator nodes
Prostatectomy (including control of postoperative bleeding, vasectomy, meatotomy, urethral calibration and/or dilation, and
internal urethrotomy); suprapubic, subtotal, one or two stages
Prostatectomy, retropubic radical, w/ or w/o nerve sparing;
w/ lymph node biopsy(s) (limited pelvic lymphadenectomy)
w/ bilateral pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes
Transperineal placement of needles, catheters or pellets into prostate for interstitial radioelement application, with or without
cystoscopy, ultrasound or CT scan guidance
Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing
Incision and drainage of vulva or perineal abscess
Incision and drainage of Bartholin's gland abscess
Marsupialization of Bartholin's gland cyst
Lysis of labial adhesions
Destruction of lesion(s), vulva; any method
Biopsy of vulva or perineum ; one lesion
Vulvectomy simple; partial
complete
Vulvectomy, radical, partial;
Partial hymenectomy or revision of hymenal ring
Hymenotomy, simple incision
Excision of Bartholin's gland or cyst
Colpotomy; w/ exploration
Destruction of vaginal lesion(s)
Biopsy of vaginal mucosa
Colpocleisis (Le Fort type)
Excision of vaginal septum
Excision of vaginal cyst or tumor
Plastic operation on urethral sphincter, vaginal approach (e.g., Kelly urethral plication)
Plastic repair of urethrocele
Posterior colporrhaphy, repair of rectocele w/ or w/o perineorrhaphy
Combined anteroposterior colporrhaphy;
w/ enterocele repair
Closure of rectovaginal fistula; vaginal or transanal approach
Removal of impacted vaginal foreign body under anesthesia
Colposcopy (Vaginoscopy)
Colposcopy; w/ biopsy(s) of the cervix and/or endocervical curettage
loop electrode excision
Trachelorrhaphy, plastic repair of uterine cervix, vaginal approach

15of22

RVU
60
85
50
25
30
50
100
50
50
75
90
90
90
25
240
300
320
320
240
300
320
320
100
300
15
25
50
25
25
25
80
150
180
50
25
50
80
20
20
180
25
50
80
80
120
150
200
120
40
30
40
75
100

ANNEX

CODE

DESCRIPTIVE TERMS

RVU

58100 Endometrial sampling (biopsy) w/ or w/o endocervical sampling (biopsy), w/o cervical dilation, any method
58120 Dilation and curettage
58145
vaginal approach
58300 Insertion of intrauterine device (IUD)
Transcervical introduction of fallopian tube catheter for diagnosis and/or re-establishing patency (any method), w/ or w/o
58345 hysterosalpingography

100

58555 Hysteroscopy, diagnostic

58558 Hysteroscopy, surgical; with sampling (biopsy) of endometrium and/or polypectomy, with or without D & C
58559
with lysis of intrauterine adhesions (any method)
58560
with division or resection of intrauterine septum (any method)
58562
with removal of impacted foreign body
58563
with endometrial ablation (e.g., endometrial resection, electrosurgical ablation thermoablation)
58660 Laparoscopy, surgical; with lysis of adhesions (salphingolysis, ovariolysis)

50
75
100
100
75
80
125

58661
58662
58670
58672
58673
58700
58720
58740
58760
58770
58800
58805
58820
58822
58825
58900
58920
58925

with removal of adnexal structures (partial or total oophorectomy and/or salpingectomy)

with fulguration or excision of lesions of the ovary, pelvic viscera, or peritoneal surface by any method
with fulguration of oviducts (with or without transection)
with fimbrioplasty
with salphingostomy (salpingoneostomy)
Salpingectomy, complete or partial, unilateral or bilateral
Salpingo-oophorectomy, complete or partial, unilateral or bilateral
Lysis of adhesions (salpingolysis, ovariolysis)
Fimbrioplasty
Salpingostomy (salpingoneostomy)
Drainage of ovarian cyst(s), unilateral or bilateral ; vaginal approach
abdominal approach
Drainage of ovarian abscess; vaginal approach
abdominal approach
Transposition, ovary(s)
Biopsy of ovary, unilateral or bilateral
Wedge resection or bisection of ovary, unilateral or bilateral
Ovarian cystectomy, unilateral or bilateral

350
90
90
125
150
120
150
150
150
150
120
120
120
120
120
100
100
150

58960

Laparotomy, for staging or restaging of ovarian malignancy ("second look"), w/ or w/o omentectomy, peritoneal washing, biopsy
of abdominal and pelvic peritoneum, diaphragmatic assessment w/ pelvic and limited para-aortic lymphadenectomy

180

59120
59121
59150
59151
59812
59870
60001
60100
60200
60210
60212
60220
60225
60240
60252
60254
60270
60271
61105
61107
61108

Surgical treatment of ectopic pregnancy; tubal or ovarian, requiring salpingectomy and/or oophorectomy, abdominal or vaginal
approach
tubal or ovarian, w/o salpingectomy and/or oophorectomy
Laparoscopic treatment of ectopic pregnancy; w/o salpingectomy and/or oophorectomy
w/ salpingectomy and/or oophorectomy
Treatment of incomplete abortion, any trimester, completed surgically
Uterine evacuation and curettage for hydatidiform mole
Aspiration and/or injection, thyroid cyst
Biopsy thyroid, percutaneous core needle
Excision of cyst or adenoma of thyroid , or transection of isthmus
Partial thyroid lobectomy, unilateral; w/ or w/o isthmusectomy
w/ contralateral subtotal lobectomy, including isthmusectomy
Total thyroid lobectomy, unilateral; w/ or w/o isthmusectomy
w/ contralateral subtotal lobectomy, including isthmusectomy
Thyroidectomy, total or complete
Thyroidectomy, total or subtotal for malignancy; w/ limited neck dissection
w/ radical neck dissection
Thyroidectomy, including substernal thyroid gland; sternal split or transhoracic approach
cervical approach
Twist drill hole for subdural or ventricular puncture; not followed by other surgery
for implanting venticular catheter or pressure recording device
for evacuation and/or drainage of subdural hematoma

16of22

50
50
100
10

180
180
180
180
50
80
40
40
120
150
200
180
200
250
250
300
300
300
100
200
250

ANNEX

CODE
61120
61140
61150
61154
61156
61250
61253
61304
61305
61312
61320
61343
61450
61518
61521
61536

DESCRIPTIVE TERMS
Burr hole(s) for ventricular puncture (including injection of gas, contrast media, dye, or radioactive material); not followed by
other surgery
Burr hole(s) or trephine; w/ biopsy of brain or intracranial lesion
w/ drainage of brain abscess or cyst
Burr hole(s) w/ evacuation and/or drainage of hematoma, extradural or subdural
Burr hole(s); w/ aspiration of hematoma or cyst, intracerebral
Burr hole(s) or trephine, supratentorial
Burr hole(s) or trephine, infratentorial, unilateral or bilateral
Craniectomy or craniotomy, exploratory; supratentorial
infratentorial (posterior fossa)
Craniectomy or craniotomy for evacuation of hematoma, supratentorial; extradural or subdural
Craniectomy or craniotomy, drainage of intracranial abscess; supratentorial
Craniectomy, suboccipital w/ cervical laminectomy for decompression of medulla and spinal cord, w/ or w/o dural graft (e.g.,
Arnold-Chiari malformation)
Craniectomy, subtemporal, for section, compression, or decompression of sensory root of gasserian ganglion
Craniectomy for excision of brain tumor, infratentorial or posterior fossa; except meningioma, cerebellopontine angle tumor, or
midline tumor at base of skull
midline tumor at base of skull
for excision of cerebral epileptogenic focus, w/ electrocorticography during surgery (includes removal of electrode array)

61556 Craniotomy for craniosynostosis; frontal or parietal bone flap

61570 Craniectomy or craniotomy; w/ excision of foreign body from brain
61571 w/ treatment of penetrating wound of brain
Infratemporal pre-auricular approach to middle cranial fossa (parapharyngeal space, infratemporal and midline skull base,
61590 nasopharynx), w/ or w/o disarticulation of the mandible, including parotidectomy, craniotomy, decompression and/or
mobilization of the facial nerve and/or petrous carotid artery
Infratemporal post-auricular approach to middle cranial fossa (internal auditory meatus, petrous apex, tentorium, cavernous sinus,
61591 parasellar area, infratemporal fossa) inlcuding mastoidectomy, resection of sigmoid sinus, w/ or w/o decompression and/or
mobilization of contents of auditory canal or petrous carotid artery
Transcatheter oclussion or embolization (e.g., for tumor destruction, to achieve hemostasis, to occlude a vascular malformation),
61624
percutaneous, any method; central nervous system (intracranial, spinal cord)
61626
non-central nervous system, head or neck (extracranial, brachiocephalic branch)
61690 Surgery of intracranial arteriovenous malformation; dural, simple
61692
dural, complex
Surgery of intracranial aneurysm, cervical approach by application of occluding clamp to cervical carotid artery (Selverstone61703
Crutchfield type)
61710
by intra-arterial embolization, injection procedure or balloon catheter
61711 Anastomosis, arterial, extracranial-intracranial (e.g., middle cerebral/cortical) arteries
Creation of lesion by stereotactic method, including burr hole(s) and localizing and recording techniques, single or multiple stages;
61720
globus pallidus or thalamus
61735 subcortical structure(s) other than globus pallidus or thalamus
61750 Stereotactic biopsy, aspiration, or excision,including burr hole(s), for intracranial lesion;
61751 w/ computerized axial tomography
61760 Stereotactic implantation of depth electrodes into the cerebrum for long term seizure monitoring
Creation of lesion by stereotactic method, percutaneous, by neurolytic agent (e.g., alcohol, thermal, electrical, radiofrequency);
61790
gasserian ganglion
61791
trigeminal medullary tract
61793 Stereotactic radiosurgery (particle beam,gamma ray or linear accelerator)
61795 Stereotactic computer assisted volumetric intracranial procedure
61855 Twist drill or burr hole(s) for implantation of neurostimulator electrodes; subcortical
61860 Craniectomy or craniotomy for implantation of neurostimulator electrodes, cerebral; cortical
61870 Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical
61875
subcortical
62000 Elevation of depressed skull fracture; simple, extradural
62005
compound or comminuted, extradural
62201 Ventriculocisternostomy, third ventricle; stereotactic method
62220 Creation of shunt; ventriculo-atrial, -jugular,-auricular

17of22

RVU
150
250
250
250
250
150
200
250
300
300
300
350
350
525
600
400
300
350
375
600

600
600
400
400
500
150
500
550
550
500
500
500
500
250
250
500
500
550
450
450
550
200
250
300
200

ANNEX

CODE
62223
62230
62268
62269
62270

DESCRIPTIVE TERMS
ventriculo-peritonial,-pleural, other terminus
Replacement or revision of CSF (VP) shunt, obstructed valve, or distal catheter in shunt system
Percutaneous aspiration, spinal cord cyst or syrinx
Biopsy of spinal cord, percutaneous needle
Spinal puncture, lumbar, diagnostic

62287 Aspiration procedure, percutaneous, of nucleus pulposus of intervertebral disk, any method, single or multiple levels, lumbar
62350
62351
62360
62361
62362
65091
65093
65101
65103
65105
65270
65273
65275
65280
65285
65286
65290
65400
65410
65420
65426
65450
65710
65730
65750
65755
65767
65770
65771
65772

Implantation, revision or repositioning of intrathecal or epidural catheter, for implantable reservoir or implantable infusion pump;
w/o laminectomy
w/ laminectomy
Implantation or replacement of device for intrathecal or epidural drug infusion; subcutaneous reservoir
non-programmable pump
programmable pump, including preparation of pump, w/ or w/o programming
Evisceration of ocular contents; w/o implant
w/ implant
Enucleation of eye; w/o implant
w/ implant, muscles not attached to implant
w/ implant, muscles attached to implant
Repair of laceration; conjunctiva, w/ or w/o nonperforating laceration sclera, direct closure
conjunctiva, by mobilization and rearrangement
cornea, nonperforating, w/ or w/o removal foreign body
cornea and/or sclera, perforating, not involving uveal tissue
cornea and/or sclera, perforating, w/ reposition or resection of uveal tissue
application of tissue glue, wounds of cornea and/or sclera
Repair of wound, extraocular muscle, tendon and/ or Tenon's capsule
Excision of lesion, cornea (keratectomy, lamellar, partial), except pterygium
Biopsy of cornea
Excision or transposition of pterygium; without graft
with graft
Destruction of lesion of cornea by cryotherapy, photocoagulation or thermocauterization
Keratoplasty (corneal transplant); lamellar
penetrating (except in aphakia)
penetrating (in aphakia)
penetrating (in pseudophakia)
Epikeratoplasty
Keratoprosthesis
Radial keratotomy
Corneal relaxing incision for correction of surgically induced astigmatism

RVU
200
150
75
75
20
150
100
250
50
100
150
80
80
80
80
80
30
30
50
120
150
50
50
40
30
40
50
30
200
200
200
200
100
200
90
90

65775 Corneal wedge resection for correction of surgically induced astigmatism

65805 Paracentesis of anterior chamber of eye; w/ therapeutic release of aqueous

90
30

65810
w/ removal of vitreous and/or discission of anterior hyaloid membrane, w/ or w/o air injection
65815
w/ removal of blood, w/ or w/o irrigation and/or air injection
65820 Goniotomy
65850 Trabeculotomy ab externo
65855 Trabeculoplasty by laser surgery, one or more sessions (defined treatment series)

50
50
150
150
80

65865 Severing adhesions of anterior segment of eye, incisional technique (w/ or w/o injection of air or liquid) ; goniosynechiae

60

65870
65875
65880
65900
65920
65930
66130
66150
66155

60
60
60
60
80
30
40
100
100

anterior synechiae, except goniosynechiae

posterior synechiae
corneovitreal adhesions
Removal of epithelial material, anterior segment eye
Removal of implanted material, anterior segment eye
Removal of blood clot, anterior segment eye
Excision of lesion, sclera
Fistulization of scalera for glaucoma; trephination w/ iridectomy
thermocauterization w/ iridectomy

18of22

ANNEX

CODE

DESCRIPTIVE TERMS

RVU

66160
66165
66170

sclerectomy w/ punch or scissors, w/ iridectomy

iridencleisis or iridotasis
trabeculectomy ab externo in absence of previous surgery

100
100
100

66172

trabeculectomy ab externo w/ scarring from previous ocular surgery or trauma (includes injection of antifibrotic agents)

180

66180
66185
66220
66225
66250
66500
66505
66600
66605
66625
66630
66680
66682
66700
66710
66720
66740

Aquenous shunt to extraocular reservoir (e.g., Molteno, Schocket, Denver-Krupin)

Revision of aqueous shunt to extraocular reservoir
Repair of scleral staphyloma; w/o graft
w/ graft
Revision or repair of operative wound of anterior segment, any type, early or late, major or minor procedure
Iridotomy by stab incision ; except transfixion
w/ transfixion as for iris bombe
Iridectomy, w/ corneoscleral or corneal section; for removal of lesion
w/ cyclectomy
peripheral for glaucoma
sector for glaucoma
Repair of iris, ciliary body (as for iridodialysis)
Suture of iris, ciliary body w/ retrieval of suture through small incision (e.g., McCannel suture)
Ciliary body destruction; diathermy
cyclophotocoagulation
cryotherapy
cyclodialysis

200
200
80
150
90
60
60
80
100
80
80
100
90
70
70
70
70

66762 Iridoplasty by photocoagulation (one or more sessions) (e.g., for improvement of vision, for widening of anterior chamber angle)

80

66770 Destruction of cyst or lesion iris or ciliary body (nonexcisional procedure)

Discission of secondary membranous cataract (opacified posterior lens capsule and/or anterior hyaloid); stab incision technique
66820
(Ziegler or Wheeler knife)
66821
laser surgery (e.g., YAG laser) (one or more stages)
66825 Repositioning of intraocular lens prosthesis, requiring an incision
Removal of secondary membranous cataract (opacified posterior lens capsule and/or anterior hyaloid) w/ corneo-scleral section,
66830
w/ or w/o iridectomy (iridocapsulotomy, iridocapsulectomy)
66852
pars plana approach, with or without vitrectomy
67005 Removal of vitreous, anterior approach (open sky technique or limbal incision); partial removal
67015 Aspiration or release of vitreous, subretinal or choroidal fluid, pars plana approach (posterior sclerotomy)
67025 Injection of vitreous substitute, pars plana or limbal approach, (fluid-gas exchange), w/ or w/o aspiration
67036 Vitrectomy, mechanical, pars plana approach;
67038
w/ epiretinal membrane stripping
67039
w/ focal endolaser photocoagulation
67040
w/ endolaser panretinal photocoagulation
67041 Vitrectomy, mechanical, pars plana approach; with internal limiting membrane (ILM) peeling
67042
with radial optic nerve neurotomy (RON)
67043
with sheathotomy for branch retinal vein occlusion
67044
with macular translocation (limited by retinotomy and/or scleral imbrication)
67045
with macular translocation (total)
67046
with removal of subretinal membranes
67047
with removal of choroidal neovascular membrane
67048
with endodrainage of subretinal hemorrhage (with or without tPA injection)
67049
with removal of dropped IOL
67050
with phacofragmentation for dropped lens material
67051
with internal tamponade with air, gas, silicone oil, perfluorocarbon liquid
67052
with insertion of scleral fixated intraocular lens, with or without anterior vitrectomy
67101 Repair of retinal detachment, one or more sessions; cryotherapy or diathermy, w/ or w/o drainage of subretinal fluid
67105
photocoagulation, w/ or w/o drainage of subretinal fluid
Repair of retinal detachment; scleral buckling (such as lamellar scleral dissection, imbrication or encircling procedure), w/ or w/o
67107
implant, w/ or w/o cryotherapy, photocoagulation, and drainage of subretinal fluid

60

19of22

80
40
100
80
180
250
50
80
300
300
300
300
300
300
300
300
300
300
300
300
300
300
300
250
300
220
300

ANNEX

CODE
67108
67110
67112
67115
67120
67121
67208
67210
67218

DESCRIPTIVE TERMS
w/ vitrectomy, any method, w/ or w/o air or gas tamponade, focal endolaser photocoagulation, cryotherapy, drainage of
subretinal fluid, scleral buckling, and/or removal of lens by same technique
by injection of air or other gas (e.g., pneumatic retinopexy)
by scleral buckling or vitrectomy, on patient having previous ipsilateral retinal detachment repair(s) using scleral buckling or
vitrectomy techniques
Release of encircling material (posterior segment)
Removal of implanted material, posterior segment; extraocular
intraocular
Destruction of localized lesion of retina (e.g., maculopathy, choroidopathy, small tumors), one or more sessions; cryotherapy,
diathermy
photocoagulation (laser or xenon arc)
radiation by implantation of source (includes removal of source)

RVU
300
200
300
80
80
120
80
80
80

67220 Destruction of localized lesion of choroid (e.g., choroidal neovascularization); photocoagulation (e.g., laser), one or more sessions

80

67221 photodynamic therapy (includes intravenous infusions

67222 transpupillary thermotherapy

80
80

67227 Destruction of extensive or progressive retinopathy (e.g., diabetic retinopathy), one or more sessions; cryotherapy, diathermy

80

67228
67250
67400
67405
67412
67413
67414
67420
67430
67440
67445
67570
67580
67582
67583
67584
67585

80
80
300
300
300
300
300
300
300
300
300
350
80
120
120
120
120

photocoagulation (laser or xenon arc)

Scleral reinforcement
Orbitotomy w/o bone flap (frontal or transconjunctival approach); for exploration, w/ or w/o biopsy
w/ drainage only
w/ removal of lesion
w/ removal of foreign body
w/ removal of bone for decompression
Orbitotomy w/ bone flap or window, lateral approach (e.g., Kroenlein); w/ removal of lesion
w/ removal of foreign body
w/ drainage
w/ removal of bone for decompression
Optic nerve decompression (e.g., incision or fenestration of optic nerve sheath)
Repair of anophthalmic socket; with insertion or removal of orbital implant within muscle cone
with exchange of orbital implant and reattachment of muscles
with fornix reconstruction using sutures
with fornix reconstruction using buccal mucosal graft or amnion graft, including harvesting of graft
with revision of implant and fornix reconstruction using sutures

67586

with revision of implant and fornix reconstruction using buccal mucosal graft, or amnion graft (including harvesting of graft)

120

67700
67710
67715
67800
67810
67875
67880
67882
67900
67908
67914
67915
67935
67950

Blepharotomy, drainage of abscess, eyelid

Severing of tarsorrhaphy
Canthotomy
Excision of chalazion
Biopsy of eyelid
Temporary closure of eyelids suture (e.g., frost suture)
Construction of intermargin adhesions, median tarsorrhaphy, or canthorrhaphy;
with transportation of tarsal plate
Repair of brow ptosis (supraciliary, midforehead or coronal approach)
conjunctivo-tarso-Muller's muscle-levator resection (Fasanella-Servat type)
Repair of ectropion: suture
thermocauterization
full thickness
Canthoplasty (reconstruction of canthus)
Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, one
stage or first stage
total eyelid, lower, one stage or first stage
total eyelid, upper, one stage or first stage
Biopsy of conjunctiva
Excision of lesion, conjunctiva; up to 1 cm

20
20
20
20
20
20
20
30
100
100
30
30
80
80

67971
67973
67974
68100
68110

20of22

200
250
250
20
30

ANNEX

CODE
68115
68130
68340
68360
68362
68400
68420
68440
68500
68510
68520
68525
68530
68540
68700
68720
68745
68750
68760
68770
68811
69100
69105
69110
69120
69140
69145
69150
69155
69220
69222
69420
69421
69433
69436
69440
69450
69501
69502
69511
69550
69552
69554
69601
69631
92975
92982
92995
93501
93510
93511
93514
93524
93526

DESCRIPTIVE TERMS
over 1 cm
with adjacent sclera
division of symblepharon, with or without insertion of conformer or contact lens
Conjunctival flap; bridge or partial
total (such as Gunderson thin flap or purse string flap)
Incision, drainage of lacrimal gland
Incision, drainage of lacrimal sac (dacryocystostomy)
Snip incision of lacrimal punctum
Excision of lacrimal gland (dacryoadenectomy), except for tumor
Biopsy of lacrimal gland
Excision of lacrimal sac (dacryocystectomy)
Biopsy of lacrimal sac
Removal of foreign body or dacryolith, lacrimal passages
Excision of lacrimal gland tumor; frontal approach
Plastic repair of canaliculi
Dacryocystorhinostomy (fistulization of lacrimal sac to nasal cavity)
conjunctivorhinostomy (fistulization of conjunctiva to nasal cavity); without tube
with insertion of tube or stent
Closure of the lacrimal punctum; by thermocauterization, ligation, or laser surgery
Closure of lacrimal fistula
Probing of nasolacrimal duct; requiring general anesthesia
Biopsy external ear
Biopsy external auditory canal
Excision external ear; partial, simple repair
complete amputation
Excision exostosis(es), external auditory canal
Excision soft tissue lesion, external auditory canal
Radical excision external auditory canal lesion; w/o neck dissection
w/ neck dissection
Debridement, mastoidectomy cavity, simple (e.g., routine cleaning)
Debridement, mastoidectomy cavity, complex (e.g., w/ anesthesia or more than routine cleaning)
Myringotomy including aspiration and/or eustachian tube inflation
Myringotomy including aspiration and/or eustachian tube inflation requiring general anesthesia
Tympanostomy (requiring insertion of ventilating tube), local or topical anesthesia
Tympanostomy (requiring insertion of ventilating tube), w/ general anesthesia
Middle ear exploration through postauricular or ear canal incision
Tympanolysis, transcanal
Transmastoid antrotomy ("simple" mastoidectomy)
Mastoidectomy; complete
radical
Excision aural glomus tumor; transcanal
transmastoid
extended (extratemporal)
Revision mastoidectomy; resulting in complete mastoidectomy
Tympanoplasty w/o mastoidectomy (including canalplasty, atticotomy and/ or middle ear surgery), initial or revision; w/o
ossicular chain reconstruction
Thrombolysis, coronary; by intracoronary infusion, including coronary angiography
Percutaneous transluminal coronary balloon angioplasty, one or more vessel
Percutaneous transluminal coronary atherectomy, by mechanical or other method, with or without balloon angioplasty, one or
more vessel
Right heart catheterization
Left heart catheterization, retrograde, from the brachial artery, axillary artery or femoral artery; percutaneous
by cutdown
Left heart catheterization by left ventricular puncture
Combined transseptal and retrograde left heart catheterization
Combined right heart catheterization and retrograde left heart catheterization

21of22

RVU
30
30
100
70
70
20
20
20
80
20
80
20
20
100
50
100
100
120
30
45
30
20
20
40
80
50
50
150
200
30
50
20
30
40
40
100
50
120
150
150
200
200
200
150
160
150
200
200
100
100
100
100
150
150

ANNEX

CODE
93527

DESCRIPTIVE TERMS
Combined right heart catheterization and transseptal left heart catheterization through intact septum (with or without retrograde
left heart catheterization)

93528 Combined right heart catheterization with left ventricular puncture (with or without retrograde left heart catheterization)
Combined right heart catheterization and left heart catheterization through existing septal opening (with or without retrograde
left heart catheterization)
93530 Right heart catheterization, for congenital cardiac anomalies
93531 Combined right heart catheterization and retrograde left heart catheterization, for congenital cardiac anomalies
93544
for aortography
93529

22of22

RVU
150
150
150
100
150
150