Medical Acts NSSF

Code Description K NSSF Coverage
Regional IV administration of local anesthetic agent to upper or lower

1995 15 ‫يساهم الصندوق‬
extremity
Daily hospital management of epidural or subarachnoid drug
administration
1997 Daily hospital management of IV controlled analgesia 7 ‫يساهم الصندوق‬
1998 Monitored care, with or without sedation, in a non-surgical procedure 12 ‫يساهم الصندوق‬
10040 Acne surgery 10 ‫ال يساهم الصندوق‬
Incision and drainage of abscess, hematoma, seroma, fluid collection, or
pilonidal cyst
10080 Incision and drainage of pilonidal cyst 10 ‫يساهم الصندوق‬
10120 Incision and removal of foreign body, subcutaneous tissues 10 ‫يساهم الصندوق‬
11044 Debridement: skin, subcutaneous tissue, muscle, and/or bone 15 ‫يساهم الصندوق‬
Biopsy of skin, subcutaneous tissue and/or mucous membrane, with or
without closure (separate procedure)
11200 Removal of skin tags, multiple fibrocutaneous tags, any area: up to 10 tags 10 ‫يساهم الصندوق‬
11300 Shaving of epidermal or superficial dermal lesions: 1 to 2 lesions 5 ‫ال يساهم الصندوق‬
Excision, benign lesion (unless listed elsewhere) except face, ears,
11400 eyelids, nose, lips, mucous membranes, with or without closure (separate 15 ‫يساهم الصندوق‬
procedure)
Excision, benign lesion (unless listed elsewhere) face, ears, eyelids, nose,
lips, mucous membranes, with or without closure (separate procedure)
11450 Excision of skin and subcutaneous tissue for hidradenitis 20 ‫يساهم الصندوق‬
Excision, malignant lesion, except face, ears, eyelids, nose, lips, mucous
membrane, with simple repair
Excision, malignant lesion, face, ears, eyelids, nose, lips, mucous
membrane, with simple repair
11752 Excision of nail and nail matrix, partial or complete 15 ‫يساهم الصندوق‬
11770 Excision of pilonidal cyst or sinus 40 ‫يساهم الصندوق‬
11900 Injection, intralesional, up to and including seven 10 ‫يساهم الصندوق‬
11920 Tattooing, intradermal 20 ‫ال يساهم الصندوق‬
11950 Subcutaneous injection of filling material eg collagen 25 ‫ال يساهم الصندوق‬
Insertion of tissue expander(s) for other than breast, including subsequent
11960 40 ‫ال يساهم الصندوق‬
expansion
11971 Removal of tissue expander(s) without insertion of prosthesis 10 ‫ال يساهم الصندوق‬
12001 Simple repair of wounds of skin 20 ‫يساهم الصندوق‬
12046 Intermediate repair (layer closure) of wounds of skin 30 ‫يساهم الصندوق‬
13101 Complex repair of wounds of skin 35 ‫يساهم الصندوق‬
Secondary closure of surgical wound or dehiscence extensive or
complicated
14000 Adjacent tissue transfer or rearrangement: defect up to 10 sq cm 50 ‫يساهم الصندوق‬
14001 Adjacent tissue transfer or rearrangement: defect 11 to 30 sq cm 55 ‫يساهم الصندوق‬
14300 Adjacent tissue transfer or rearrangement: defect more than 30 sq cm 65 ‫يساهم الصندوق‬
14350 Filleted finger or toe flap, including preparation of recipient site 55 ‫يساهم الصندوق‬
Excisional preparation/creation of recipient site by excision of intact skin,
15000 including subcutaneous tissues, scar, etc prior to repair with free skin 15 ‫يتطلب موافقة‬
graft (list separately in addition to skin graft)
Split graft, trunk, scalp, arms, legs, hands, and/or feet: 100 sq cm or less,
15100 50 ‫يتطلب موافقة‬
or each 1% of body area of infants and children
Split graft, face, eyelids, mouth, neck, ears, orbits, genitalia, and/or
15120 multiple digits: 100 sq cm or less, or each 1% of body area of infants and 55 ‫يتطلب موافقة‬
children
Split graft, each additional 100 sq cm or 1% of body area of infants and
children, add
Full thickness graft, free, including direct closure of donor site, other than
nose, ears, eyelids, and/or lips: up to 20 sq cm
Full thickness graft, free, including direct closure of donor site, other than
nose, ears, eyelids, and/or lips:each additional 20 sq cm
Full thickness graft, free, including direct closure of donor site, nose,
ears, eyelids, and/or lips: up to 20 sq cm
Full thickness graft, free, including direct closure of donor site, nose ears,
eyelids, and/or lips: each additional 20 sq cm
15350 Application of allograft, or xenograft, skin 30 ‫يتطلب موافقة‬
15570 Formation of direct or tubed pedicle, first stage 35 ‫يساهم الصندوق‬
15580 Cross finger flap, including free graft to donor site 45 ‫يتطلب موافقة‬
15650 Transfer of any tubed pedicle flap, any location (second stage) 25 ‫يتطلب موافقة‬
15732 Muscle, myocutaneous, or fasciocutaneous flap 80 ‫يتطلب موافقة‬
15740 Flap: island pedicle 70 ‫يتطلب موافقة‬
15750 Flap: neurovascular pedicle 75 ‫يتطلب موافقة‬
15755 Free flap (microvascular transfer) (two surgical teams procedure) 200 ‫يتطلب موافقة‬
Graft: composite graft (full thickness of external ear or nasal ala),
including primary closure
15770 Graft: derma-fat fascia 60 ‫يتطلب موافقة‬
15780 Dermabrasion: total face 50 ‫ال يساهم الصندوق‬
15781 Dermabrasion: regional face or elsewhere 30 ‫ال يساهم الصندوق‬
15786 Abrasion: single lesion (eg, keratosis, scar) 10 ‫ال يساهم الصندوق‬
15790 Chemical peel: total face 40 ‫ال يساهم الصندوق‬
15791 Chemical peel: regional, face, hand, or elsewhere 40 ‫ال يساهم الصندوق‬
15819 Cervicoplasty 55 ‫ال يساهم الصندوق‬
15820 Blepharoplasty 40 ‫يتطلب موافقة‬
15824 Rhytidectomy: 70 ‫ال يساهم الصندوق‬
15831 Excision, excessive skin and subcutaneous tissue (including lipectomy) 70 ‫ال يساهم الصندوق‬
Graft for facial nerve paralysis: free muscle graft by microsurgical
technique, includes obtaining graft (two surgical teams procedure)
15845 Graft for facial nerve paralysis: regional muscle transfer or fascia graft 80 ‫يساهم الصندوق‬
15850 Removal of sutures under anesthesia 15 ‫يساهم الصندوق‬
15876 Suction assisted lipectomy: head and neck 90 ‫ال يساهم الصندوق‬
15877 Suction assisted lipectomy: trunk 70 ‫ال يساهم الصندوق‬
15878 Suction assisted lipectomy: upper extremity 60 ‫ال يساهم الصندوق‬
15879 Suction assisted lipectomy: lower extremity 90 ‫ال يساهم الصندوق‬
Excision decubitus ulcer, coccygeal, with coccygectomy: with primary
suture
15922 Excision decubitus ulcer, coccygeal, with coccygectomy: with flap closure 60 ‫يساهم الصندوق‬
Excision decubitus ulcer, sacral, ischial, or trochanteric, with or without
ostectomy
16000 Initial treatment, first degree burn, requiring only local treatment 5 ‫يساهم الصندوق‬
Dressings and/or debridement, initial or subsequent: under general
anesthesia, up to 9% of total body surface area
Dressings and/or debridement, initial or subsequent: under general
anesthesia, face or hand, or over 9% of total body surface area
Dressings and/or debridement, initial or subsequent: without anesthesia,
up to 9% of total body surface area
Dressings and/or debridement, initial or subsequent: without anesthesia,
face or hand, or over 9% of total body surface area
Excision of burn wound, without skin grafting, employing alloplastic
dressing, any anatomic site: up to 9% of total body surface area
Excision of burn wound, without skin grafting, employing alloplastic
dressing, any anatomic site: over 9% of total body surface area
Destruction by any method, with or without surgical curettement, of
17000 benign facial, or benign premalignant lesions (not cutaneous vascular 10 ‫يساهم الصندوق‬
proliferative lesions) in any location: up to 3 lesions
Destruction of cutaneous vascular proliferative lesions (eg, laser
technique): up to 5 sq cm
technique): 5 to 15 sq cm
technique): 15 to 50 sq cm
17304 Chemosurgery (Mohs type technique) malignancies of skin 50 ‫يساهم الصندوق‬
17340 Cryotherapy (CO2 slush, liquid nitrogen), per session 10 ‫ال يساهم الصندوق‬
17360 Chemical exfoliation for acne (acne paste, acid, etc..) 10 ‫ال يساهم الصندوق‬
17380 Electrolysis epilation, each half hour 10 ‫ال يساهم الصندوق‬
19000 Puncture aspiration of cyst of breast, office procedure 5 ‫يساهم الصندوق‬
19020 Mastotomy with exploration and drainage of abscess, deep 20 ‫يساهم الصندوق‬
19030 Injection procedure only for mammary ductogram or galactogram 10 ‫يساهم الصندوق‬
19100 Biopsy of breast: needle aspiration (separate procedure) 10 ‫يساهم الصندوق‬
19101 Biopsy of breast: incisional (separate procedure) 30 ‫يساهم الصندوق‬
19140 Mastectomy for gynecomastia 40 ‫ال يساهم الصندوق‬
19160 Mastectomy, partial, for excision of cyst or tumor 40 ‫يساهم الصندوق‬
19162 Mastectomy, partial: with axillary lymphadenectomy 100 ‫يساهم الصندوق‬
19180 Mastectomy, simple, complete 60 ‫يساهم الصندوق‬
19200 Mastectomy, radical, including pectoral muscles, axillary lymph nodes 100 ‫يساهم الصندوق‬
Mastectomy, modified radical, including axillary lymph nodes with or
without pectoralis minor muscle, but excluding pectoralis major muscle
19260 Excision of chest wall tumor involving ribs 100 ‫يساهم الصندوق‬
Excision of chest wall tumor involving ribs, with plastic reconstruction:
with or without mediastinal lymphadenectomy
19290 Preoperative placement of needle localization wire: breast, each lesion 10 ‫يساهم الصندوق‬
19316 Mastopexy 70 ‫ال يساهم الصندوق‬
19318 Reduction mammaplasty 70 ‫ال يساهم الصندوق‬
19324 Mammaplasty, augmentation: without prosthetic implant 50 ‫ال يساهم الصندوق‬
19328 Removal of mammary implant (intact implant or implant material) 50 ‫ال يساهم الصندوق‬
Immediate insertion of breast prosthesis following mastopexy,
mastectomy or in reconstruction
Delayed insertion of breast prosthesis following mastopexy, mastectomy
or in reconstruction
19350 Nipple/areola reconstruction or correction of inverted nipples 50 ‫ال يساهم الصندوق‬
Breast reconstruction, immediate or delayed, with tissue expander,
including subsequent expansion
Breast reconstruction with latissimus dorsi flap, with or without
prosthetic [mplant
19364 Breast reconstruction with free flap 170 ‫ال يساهم الصندوق‬
Breast reconstruction with transverse rectus abdominis flap (TRAM),
19367 including closure of donor site, single or double pedicle, with or without 165 ‫ال يساهم الصندوق‬
microvascular anastomosis
19370 Open periprosthetic capsulotomy or capsulectomy, breast 50 ‫ال يساهم الصندوق‬
19380 Revision of reconstructed breast 55 ‫ال يساهم الصندوق‬
20000 Incision of soft tissue abscess (eg, secondary to osteomyelitis) 15 ‫يساهم الصندوق‬
20200 Biopsy, muscle, superficial 15 ‫يساهم الصندوق‬
20205 Biopsy, muscle, deep 25 ‫يساهم الصندوق‬
20206 Biopsy, muscle: percutaneous needle 10 ‫يساهم الصندوق‬
Biopsy, bone, trocar or needle: superficial (eg, ilium, sternum, spinous
process, ribs)
20225 Biopsy, bone, trocar or needle: deep (vertebral body, femur) 15 ‫يساهم الصندوق‬
20240 Biopsy, bone, excisional (e.g.ilium, sternum, spinous process, rib, etc.) 15 ‫يساهم الصندوق‬
20250 Biopsy, vertebral body, open: posterior approach 40 ‫يساهم الصندوق‬
20251 Biopsy, vertebral body, open: anterior approach 80 ‫يساهم الصندوق‬
20500 Injection of sinus tract: diagnostic or therapeutic (separate procedure) 10 ‫يساهم الصندوق‬
20520 Removal of foreign body in muscle or tendon sheath: simple 15 ‫يساهم الصندوق‬
20525 Removal of foreign body in muscle or tendon sheath: deep or complicated 30 ‫يساهم الصندوق‬
20550 Injection, tendon sheath, ligament, trigger points or ganglion cyst 10 ‫يساهم الصندوق‬
20600 Arthrocentesis, aspiration and/or injection 10 ‫يساهم الصندوق‬
20615 Aspiration and injection for treatment of bone cyst 15 ‫يساهم الصندوق‬
Insertion of wire or pin with application of skeletal traction, including
removal (separate procedure)
Application of cranial tongs, caliper, or stereotactic frame, including
removal (separate procedure)
20661 Application of halo, including removal 30 ‫يساهم الصندوق‬
20665 Removal of tongs or halo applied by another physician 10 ‫يساهم الصندوق‬
Application of a uniplane (pins or wires in one plane), unilateral, external
20690 fixation system(list in addition to code for treatment of closed or open 30 ‫يساهم الصندوق‬
fracture)
Application of a multiplane (pins or wires in more than one plane),
20692 unilateral, external fixation system (eg, Ilizarov,Monticelli type) (list in 45 ‫يساهم الصندوق‬
addition to code for fracture)
Adjustment or revision of external fixation system requiring anesthesia
(eg, new pin(s) or wire(s), and/or new ring(s) or bar(s))
20694 Removal of external fixation system 20 ‫يساهم الصندوق‬
20802 Replantation, arm 300 ‫يساهم الصندوق‬
20805 Replantation, forearm 310 ‫يساهم الصندوق‬
20808 Replantation, hand 320 ‫يساهم الصندوق‬
20816 Replantation, digit , excluding thumb, complete amputation 165 ‫يساهم الصندوق‬
20822 Replantation , digit, excluding thumb, incomplete amputation 135 ‫يساهم الصندوق‬
20824 Replantation, thumb 190 ‫يساهم الصندوق‬
20838 Replantation, leg or foot 300 ‫يساهم الصندوق‬
20900 Bone graft, any donor area 35 ‫يساهم الصندوق‬
20910 Cartilage graft 40 ‫يساهم الصندوق‬
20920 Fascia lata graft 35 ‫يساهم الصندوق‬
20924 Tendon graft, from a distance (eg, palmaris, toe extensor, plantaris) 40 ‫يساهم الصندوق‬
Monitoring of interstitial fluid pressure (includes insertion of device) in
detection of muscle compartment syndrome
20955 Bone graft with microvascular anastomosis 180 ‫يساهم الصندوق‬
20969 Free osteocutaneous flap with microvascular anastomosis 180 ‫يساهم الصندوق‬
Electrical stimulation to aid bone healing: non-invasive (non-operative)
(list in additon to code for bony procedure, when applicable)
Electrical stimulation to aid bone healing: invasive (operative) (list in
addition to code for appropriate bony procedure, when applicable)
Radical resection of tumor (eg, malignant neoplasm) of soft tissues of
face or scalp
Excision of bone (eg, for osteomyelitis or bone abscess): mandible or
facial bone(s)
Removal by contouring of benign tumor of facial bone (eg, fibrous
dysplasia)
21030 Excision of benign tumor or cyst of facial bone other than mandible 50 ‫يساهم الصندوق‬
21031 Excision of torus mandibularis 15 ‫يساهم الصندوق‬
21032 Excision of maxillary torus palatinus 30 ‫يساهم الصندوق‬
21034 Excision of malignant tumor of facial bone other than mandible 105 ‫يساهم الصندوق‬
21040 Excision of benign cyst or tumor of mandible: simple 15 ‫يساهم الصندوق‬
21041 Excision of benign cyst or tumor of mandible: complex 40 ‫يساهم الصندوق‬
21044 Excision of malignant tumor of mandible 75 ‫يساهم الصندوق‬
21045 Excision of malignant tumor of mandible: radical resection 105 ‫يساهم الصندوق‬
21050 Condylectomy, temporomandibular joint (separate procedure) 70 ‫يساهم الصندوق‬
Meniscectomy, partial or complete, temporomandibular joint (separate
procedure)
21070 Coronoidectomy (separate procedure) 60 ‫يساهم الصندوق‬
Application of halo type appliance for maxillo-facial fixation,
etc..includes removal (separate procedure)
Application of interdental fixation device for conditions other than
fracture or dislocation, includes removal
21116 Injection procedure for temporomandibular joint arthrography 5 ‫يساهم الصندوق‬
21120 Genioplasty: augmentation (autograft, allograft, prosthetic material) 45 ‫ال يساهم الصندوق‬
21121 Genioplasty: sliding osteotomy, single piece 50 ‫ال يساهم الصندوق‬
Genioplasty: sliding osteotomies, two or more osteotomies (eg, wedge
excision or bone wedge reversal for asymmetrical chin)
Genioplasty: sliding, augmentation with interpositional bone grafts
(includes obtaining autografts)
21125 Augmentation, mandibular body or angle: prosthetic material 50 ‫ال يساهم الصندوق‬
Augmentation, mandibular body or angle: with bone graft, onlay or
interpositional (includes obtaining autograft), unilateral
Reduction forehead: contouring and/or application of prosthetic material
or bone graft (includes obtaining autograft)
21139 Reduction forehead: contouring and setback of anterior frontal sinus wall 140 ‫ال يساهم الصندوق‬
Reconstruction midface, LeFort I: intrusion, single piece (eg, for Long
Face Syndrome)
Reconstruction midface, LeFort I: single piece, segment movement in any
direction, requiring bone grafts (includes obtaining autografts)
Reconstruction midface, LeFort I: three or more pieces, segment
21147 movement in any direction, requiring bone grafts (includes obtaining 220 ‫ال يساهم الصندوق‬
autografts) (eg, ungrafted bilateral alveolar cleft or multiple osteotomies)
Reconstruction midface, LeFort II: anterior intrusion (eg, Treacher-
Collins Syndrome)
Reconstruction midface, LeFort II: any direction, requiring bone grafts
(includes obtaining autografts)
Reconstruction midface, LeFort III (extracranial), any type, requiring
bone grafts (includes obtaining autografts): without LeFort I
Reconstruction midface, LeFort III (extracranial), any type, requiring
bone grafts (includes obtaining autografts): with LeFort I
Reconstruction midface, LeFort III (extra and intracranial) with forehead
21159 advancement (eg, mono bloc), requiring bone grafts (includes obtaining 270 ‫ال يساهم الصندوق‬
autografts): without LeFort I
Reconstruction superior-lateral orbital rim and lower forehead,
21172 advancement or alteration, with or without grafts (includes obtaining 210 ‫ال يساهم الصندوق‬
autografts)
Reconstruction, bifrontal, superior-lateral orbital rims and lower
21175 forehead, advancement or alteration, with or without grafts (includes 240 ‫ال يساهم الصندوق‬
obtaining autografts)
Reconstruction, entire or majority of forehead and/or supraorbital rims:
with grafts (allograft or prosthetic material)
Reconstruction, entire or majority of forehead and/or supraorbital rims:
with autograft (includes obtaining grafts)
Removal by contouring of benign tumor of cranial bones (eg, fibrous
dysplasia), extracranial
Reconstruction of orbital walls, rims, forehead, nasoethmoid complex
21182 following intra-/extra-cranial excision of benign tumor of cranial bone, 240 ‫يساهم الصندوق‬
with multiple autografts: graft area less than 40 cm2
Reconstruction of orbital walls, rims, forehead, nasoethmoid complex
21183 following intra-/extra-cranial excision of benign tumor of cranial bone, 280 ‫يساهم الصندوق‬
with multiple autografts
Reconstruction midface, osteotomies (other than LeFort type) and bone
grafts (includes obtaining autografts)
21193 Reconstruction of mandibular ramus, horizontal, vertical, 0 ‫ال يساهم الصندوق‬
21194 Reconstruction of mandibular ramus, horizontal, vertical, 0 ‫ال يساهم الصندوق‬
Reconstruction of mandibular ramus, sagittal split: without internal rigid
fixation
Reconstruction of mandibular ramus, sagittal split: with internal rigid
fixation
21198 Osteotomy, mandible or maxilla, segmental 140 ‫ال يساهم الصندوق‬
Osteoplasty, facial bones: augmentation (autograft, allograft or
prosthetic implant)
21209 Osteoplasty, facial bones: reduction 50 ‫ال يساهم الصندوق‬
21210 Graft, bone: nasal, maxillary or malar areas (includes obtaining graft) 75 ‫ال يساهم الصندوق‬
21215 Graft, bone: mandible (includes obtaining graft) 75 ‫ال يساهم الصندوق‬
Graft: rib cartilage, autogenous, to face, nose or ear (includes obtaining
graft)
21235 Graft: ear cartilage, autograft, to nose or ear (includes obtainig graft) 75 ‫ال يساهم الصندوق‬
Arthroplasty, temporomandibular joint, with or without autograft
(includes obtaining graft)
21242 Arthroplasty, temporomandibular joint, with allograft 85 ‫يساهم الصندوق‬
21243 Arthroplasty, temporomandibular joint, with prosthetic joint replacement 115 ‫يساهم الصندوق‬
Reconstruction of mandible, extraoral, with transosteal bone plate (eg,
mandibular staple bone plate)
21245 Reconstruction of mandible or maxilla, subperiosteal implant 75 ‫يساهم الصندوق‬
Reconstruction of mandibular condyle with bone and cartilage autografts
(includes obtaining grafts) (eg, for hemifacial microsomia)
Reconstruction of mandible or maxilla, endosteal implant (eg, blade,
cylinder): partial
Reconstruction of mandible or maxilla, endosteal implant (eg, blade,
cylinder): complete
Reconstruction of zygomatic arch and glenoid fossa with bone and
cartilage (includes obtaining autografts)
Reconstruction of orbit with osteotomies (extracranial) and with bone
grafts (includes obtaining autografts) (eg, microphthalmia)
Periorbital osteotomies for orbital hypertelorism, with bone grafts:
extracranial approach
Periorbital osteotomies for orbital hypertelorism, with bone grafts: any
method
Orbital repositioning, periorbital osteotomies, unilateral, with bone
grafts: extracranial approach
Orbital repositioning, periorbital osteotomies, unilateral, with bone
grafts: combined intra- and extra-cranial approach
21270 Malar augmentation, prosthetic material 75 ‫ال يساهم الصندوق‬
21275 Secondary revision of orbitocranial reconstruction 75 ‫يساهم الصندوق‬
21280 Medial canthopexy (separate procdure) 40 ‫يساهم الصندوق‬
21282 Lateral canthopexy 30 ‫يساهم الصندوق‬
Reduction of masseter muscle and bone (eg, for treatment of benign
masseteric hypertrophy): extraoral approach
Reduction of masseter muscle and bone (eg, for treatment of benign
masseteric hypertrophy): intraoral approach
Closed treatment, nasal bone or septum fracture: with or without
stabilization
Open treatment of nasal fracture: with internal and/or external skeletal
fixation, with or without concomitant open treatment of fractured septum
21338 Open treatment of nasoethmoid fracture: with or without external fixation 50 ‫يساهم الصندوق‬
Treatment of nasoethmoid complex fracture, with splint, wire, or headcap
21340 fixation, including repair of canthal ligaments and/or nasolacrimal 75 ‫يساهم الصندوق‬
apparatus
21343 Open treatment of depressed frontal sinus fracture 80 ‫يساهم الصندوق‬
Open treatment of complicated (eg, comminuted or involving posterior
wall) frontal sinus fracture, via coronal or multiple approaches
Closed treatment of nasomaxillary complex fracture (LeFort II type), with
interdental wire fixation or fixation of denture or splint
Open treatment of nasomaxillary complex fracture (LeFort II type): with
wiring and/or local fixation
Open treatment of nasomaxillary complex fracture (LeFort II type):
21347 requiring multiple open approaches or bone grafting (includes obtaining 80 ‫يساهم الصندوق‬
graft)
Percutaneous treatment of fracture of malar area, including zygomatic
arch and malar tripod, with manipulation
21356 Open treatment of depressed zygomatic arch fracture (eg, Gilles approach) 30 ‫يساهم الصندوق‬
Open treatment of depressed malar fracture, including zygomatic arch
and malar tripod
Open treatment of complicated fractures of malar area, including
21365 zygomatic arch and malar tripod: with internal skeletal fixation and with 80 ‫يساهم الصندوق‬
multiple surgical approaches
Open treatment of complicated (eg, comminuted or involving cranial
21366 nerve foramina) fracture(s) of malar area, including zygomatic arch and 90 ‫يساهم الصندوق‬
malar tripod: with bone grafting (includes obtaining graft)
Open treatment of orbital floor blowout fracture:periorbital approach
with or without alloplastic or other implant
Open treatment of orbital floor blowout fracture:periorbital approach
with bone graft (includes obtaining graft)
21401 Closed treatment of fracture of orbit, except blowout with manipulation 20 ‫يساهم الصندوق‬
21406 Open treatment of fracture of orbit, exceptbloout without implant 45 ‫يساهم الصندوق‬
21407 Open treatment of fracture of orbit, except blowout with implant or graft 55 ‫يساهم الصندوق‬
Closed treatment of palatal or maxillary fracture (LeFort I type): with
interdental wire fixation or fixation of denture or splint
21422 Open treatment of palatal or alveolar ridge fractures (LeFort I type) 55 ‫يساهم الصندوق‬
Open treatment of palatal or maxillary fracture (LeFort I type):
21423 complicated (comminuted or involving cranial nerve foramina), multiple 60 ‫يساهم الصندوق‬
approaches
Closed treatment of craniofacial separation (LeFort III type) using
interdental wire fixation of denture or splint
Open treatment of craniofacial separation (LeFort III type): with wiring
and/or internal fixation
Open treatment of craniofacial separation (LeFort III type): complicated
21433 (eg, comminuted or involving cranial nerve foramina, multiple surgical 180 ‫يساهم الصندوق‬
approaches)
Open treatment of craniofacial separation (LeFort III type): complicated,
21436 multiple surgical approaches, with internal fixation, and bone graft 135 ‫يساهم الصندوق‬
Open treatment of mandibular or maxillary alveolar ridge fracture
(separate procedure)
Closed treatment of mandibular fracture: with manipulation and internal
fixation
Percutaneous treatment of mandibular fracture: with external or
interdental fixation
21454 Open treatment of mandibular fracture with external fixation 40 ‫يساهم الصندوق‬
Open treatment of closed or open mandibular fracture: with or without
interdental fixation
21465 Open treatment of mandibular condylar fracture 65 ‫يساهم الصندوق‬
Open treatment of complicated mandibular fracture by multiple surgical
21470 approaches, including internal fixation, interdental fixation, and/or wiring 100 ‫يساهم الصندوق‬
of dentures or splints
21480 Closed treatment of temporomandibular dislocation, initial or subsequent 5 ‫يساهم الصندوق‬
Closed treatment of temporomandibular dislocation, complicated (eg,
recurrent requiring intermaxillary fixation or splinting)
21490 Open treatment of temporomandibular dislocation 40 ‫يساهم الصندوق‬
21493 Closed treatment of hyoid fracture: without manipulation 10 ‫يساهم الصندوق‬
21494 Closed treatment of hyoid fracture: with manipulation 30 ‫يساهم الصندوق‬
21495 Open treatment of hyoid fracture 30 ‫يساهم الصندوق‬
21497 Interdental wiring for condition other than fracture 25 ‫يساهم الصندوق‬
Incision and drainage of deep abscess or hematoma of soft tissues of neck
or thorax
Incision and drainage, deep abscess or hematoma, soft tissues of neck or
thorax: with partial rib ostectomy
Incision, deep, with opening of bone cortex (eg, for osteomyelitis or bone
abscess), thorax
21550 Biopsy, soft tissue of neck or thorax 15 ‫يساهم الصندوق‬
21555 Excision of tumor, soft tissue of neck or thorax: subcutaneous 15 ‫يساهم الصندوق‬
Excision of tumor of soft tissue of neck or thorax: deep, subfascial, or
intramuscular
Radical resection of tumor (eg, malignant neoplasm) of soft tissue of neck
or thorax
21600 Excision of rib, partial 35 ‫يساهم الصندوق‬
21610 Costotransversectomy (separate procedure) 45 ‫يساهم الصندوق‬
Excision first and/or cervical rib for outlet compression syndrome or
other cause: with or without sympathectomy
21620 Ostectomy of sternum, partial 35 ‫يساهم الصندوق‬
21627 Sternal debridement 30 ‫يساهم الصندوق‬
21630 Radical resection of sternum: for tumor or osteomyelitis 80 ‫يساهم الصندوق‬
21632 Radical resection of sternum: with mediastinal lymphadenectomy 115 ‫يساهم الصندوق‬
21700 Division of scalenus anticus: without resection of cervical rib 35 ‫يساهم الصندوق‬
21705 Division of scalenus anticus: with resection of cervical rib 65 ‫يساهم الصندوق‬
Division of sternocleidomastoid for torticollis, open operation: with or
without cast application
21740 Reconstructive repair of pectus excavatum or carinatum 85 ‫يساهم الصندوق‬
Closure of sternotomy separation with or without debridement (separate
procedure)
21805 Open treatment of rib fracture: without fixation, each 15 ‫يساهم الصندوق‬
21810 Treatment of rib fracture: requiring external fixation (flail chest) 35 ‫يساهم الصندوق‬
21825 Open treatment of sternum fracture with or without skeletal fixation 35 ‫يساهم الصندوق‬
21920 Biopsy, soft tissue of back or flank 25 ‫يساهم الصندوق‬
21930 Excision, tumor, soft tissue of back or flank 40 ‫يساهم الصندوق‬
back or flank
Partial resection of posterior vertebral component (spinous processes,
22100 lamina or facet) for intrinsic bony lesion, single vertebral segment: 50 ‫يساهم الصندوق‬
cervical, thoracic or lumbar
Partial resection of posterior vertebral component (spinous process,
lamina or facet) for intrinsic bony lesion: cervical, thoracic or lumbar,
each additional segment (list separately in addition to code for primary
procedure)
Partial excision of vertebral body, for intrinsic bony lesion, without
22110 decompression of spinal cord or nerve root(s), single vertebral segment: 80 ‫يساهم الصندوق‬
cervical, thoracic, or lumbar
Partial excision of vertebral body, for intrinsic bony lesion, without
decompression of spinal cord or nerve root)s): cervical, thoracic or
lumbar, each additional segment (list separately in addition to code for
primary procedure)
Osteotomy of spine, posterior or anterior approach, for correction of
deformity, single segment: cervical, thoracic or lumbar
Osteotomy of spine, posterior or anterior approach, for correction of
22226 deformity, each additional segment (list separately in addition to code 50 ‫يساهم الصندوق‬
for primary procedure)
22305 Closed treatment of vertebral process fracture, one or more 15 ‫يساهم الصندوق‬
Closed treatment of vertebral body fracture, one or more, without
manipulation
Closed treatment of vertebral body fracture and/or dislocation, with or
without anesthesia, by manipulation or traction, each
Open treatment of vertebral fracture and/or dislocation: cervical, thoracic
or lumbar, each
22505 Spine manipulation requiring anesthesia, any region 15 ‫يساهم الصندوق‬
Arthrodesis, anterior transoral or extraoral technique, clivus-C1-C2 (atlas-
22548 axis), with bone graft, with or without excision of odontoid process 140 ‫يساهم الصندوق‬
Arthrodesis, anterior interbody technique: cervical below C2, with bone
graft (separate procedure)
Arthrodesis, anterior interbody technique: thoracic, with local bone (eg,
rib) and/or bone allograft (separate procedure)
Arthrodesis, anterior interbody technique: lumbar, with bone graft
Arthrodesis, anterior or anterolateral, each additional interspace (list
separately in addition to single level arthrodesis)
Arthrodesis, posterior technique, craniocervical,atlas-axis or cervical
below C2, with bone graft and/or internal fixation (separate procedure)
Arthrodesis, posterior or posterolateral technique, with local bone or bone
allograft and/or internal fixation: thoracic or lumbar (separate procedure)
Arthrodesis, lateral transverse process technique, with local bone or bone
allograft and/or internal wire fixation, lumbar (separate procedure)
Arthrodesis, posterior interbody technique, with local bone or bone
allograft and/or internal wire fixation, lumbar (separate procedure)
Arthrodesis, posterior, posterolateral or lateral transverse process
22632 technique, each additional interspace (list separately in addition to code 45 ‫يساهم الصندوق‬
for single level arthrodesis)
Arthrodesis, posterior, for spinal deformity, with or without cast, with
bone graft: 6 or less vertebrae
Arthrodesis, posterior, for spinal deformity, with or without cast, with
bone graft: 7 or more vertebrae
Arthrodesis, anterior, for spinal deformity, with or without cast, with
bone graft: 4 to 7 vertebrae
Arthrodesis, anterior, for spinal deformity, with or without cast, with
bone graft: 8 or more vertebrae
22830 Exploration of spinal fusion 50 ‫يساهم الصندوق‬
Spinal instrumentation, posterior: without segmental fixation (eg, single
Harrington rod technique)
Spinal instrumentation, posterior: segmental fixation (eg, pedicle fixation,
dual rods with multiple hooks and sublaminal wires)
22845 Spinal instrumentation, anterior 160 ‫يساهم الصندوق‬
22849 Reinsertion of spinal fixation device 80 ‫يساهم الصندوق‬
22855 Removal of anterior or posterior segmental spinal instrumentation 75 ‫يساهم الصندوق‬
22900 Excision, abdominal wall tumor, subfascial (eg, desmoid) 35 ‫يساهم الصندوق‬
Removal of subdeltoid (or intratendinous) calcareous deposits, open
method
23020 Capsular contracture release (Sever type procedure) for Erb's palsy 50 ‫يساهم الصندوق‬
Incision and drainage, shoulder area: deep abscess or hematoma or
infected bursa
Incision, deep, with opening of cortex (eg, for osteomyelitis or bone
abscess), shoulder area
Arthrotomy, glenohumeral joint, for infection, with exploration, drainage
or removal of foreign body
Arthrotomy, acromioclavicular, sternoclavicular joint, for infection, with
exploration, drainage or removal of foreign body
23065 Biopsy, soft tissue of shoulder area: superficial 20 ‫يساهم الصندوق‬
23066 Biopsy, soft tissue of shoulder area: deep 40 ‫يساهم الصندوق‬
23075 Excision, tumor, shoulder area: subcutaneous 20 ‫يساهم الصندوق‬
23076 Excision, tumor, shoulder area: deep, subfascial or intramuscular 50 ‫يساهم الصندوق‬
shoulder area
23100 Arthrotomy for biopsy, glenohumeral joint 40 ‫يساهم الصندوق‬
Arthrotomy for biopsy or for excision of torn cartilage,
acromioclavicular, sternoclavicular joint
23105 Arthrotomy for synovectomy: glenohumeral or sternoclavicular joint 50 ‫يساهم الصندوق‬
Arthrotomy, glenohumeral joint, with joint exploration, with or without
removal of loose or foreign body
23120 Claviculectomy: partial or total 55 ‫يساهم الصندوق‬
23130 Acromioplasty or acromionectomy, partial 55 ‫يساهم الصندوق‬
23140 Excision or curettage of bone cyst or benign tumor of clavicle or scapula 40 ‫يساهم الصندوق‬
Excision or curettage of bone cyst or benign tumor of clavicle, scapula or
23145 proximal humerus: with autograft (includes obtaining graft) or with 65 ‫يساهم الصندوق‬
allograft
Sequestrectomy (eg, for osteomyelitis or bone abscess), humeral head to
surgical neck, clavicle or scapula
Partial excision (craterization, saucerization, or diaphysectomy) of bone
(eg, for osteomyelitis), clavicle or scapula
Partial excision (craterization, saucerization, or diaphysectomy) of bone
(eg, for osteomyelitis), proximal humerus
23190 Ostectomy of scapula, partial 50 ‫يساهم الصندوق‬
23200 Radical resection for tumor: clavicle, scapula or proximal humerus 75 ‫يساهم الصندوق‬
Radical resection for tumor, proximal humerus: with autograft (includes
obtaining graft) or with prosthetic replacement
23330 Removal of foreign body, shoulder: subcutaneous 20 ‫يساهم الصندوق‬
23331 Removal of foreign body, shoulder: deep (eg, Neer prosthesis removal) 45 ‫يساهم الصندوق‬
23332 Removal of foreign body, shoulder: complicated, including total shoulder 65 ‫يساهم الصندوق‬
23350 Injection procedure for shoulder arthrography 10 ‫يساهم الصندوق‬
23395 Muscle transfer, any type for paralysis of shoulder or upper arm: single 75 ‫يساهم الصندوق‬
23397 Muscle transfer, any type for paralysis of shoulder or upper arm: multiple 115 ‫يساهم الصندوق‬
23400 Scapulopexy (eg, Sprengel's deformity or for paralysis) 75 ‫يساهم الصندوق‬
23406 Tenomyotomy, shoulder area: single or multiple through same incision 55 ‫يساهم الصندوق‬
Repair of ruptured supraspinatus tendon (rotator cuff) or
musculotendinous cuff: acute or chronic
23415 Coracoacromial ligament release, with or without acromioplasty 55 ‫يساهم الصندوق‬
Repair of complete shoulder (rotator) cuff avulsion, chronic (includes
acromioplasty)
23430 Tenodesis for rupture of long tendon of biceps 55 ‫يساهم الصندوق‬
Resection or transplantation of long tendon of biceps, for chronic
tenosynovitis
Capsulorrhaphy for recurrent dislocation of shoulder, anterior or
posterior, any method, any type
Arthroplasty with glenoid and proximal humeral implant or replacement
(eg, total shoulder)
23480 Osteotomy, clavicle, without internal fixation 40 ‫يساهم الصندوق‬
Osteotomy, clavicle, with internal fixation or bone graft for nonunion or
malunion (includes obtaining graft and/or necessary fixation)
23505 Closed treatment of clavicular fracture: with manipulation 20 ‫يساهم الصندوق‬
Open treatment of clavicular fracture, with or without internal or external
skeletal fixation
23525 Closed treatment of sternoclavicular dislocation: with manipulation 20 ‫يساهم الصندوق‬
Open treatment of sternoclavicular dislocation, acute or chronic: with or
without fascial graft (includes obtaining graft)
23545 Treatment of closed acromioclavicular dislocation: with manipulation 20 ‫يساهم الصندوق‬
Open treatment of closed or open acromioclavicular dislocation, acute or
chronic, without graft
Open treatment of closed or open acromioclavicular dislocation, acute or
chronic: with fascial graft (includes obtaining graft)
Closed treatment of scapular fracture: with manipulation, with or without
skeletal traction (with or without shoulder joint involvement)
Open treatment of scapular fracture (body, glenoid or acromion) with or
without internal fixation
Closed treatment of proximal humeral (surgical or anatomical neck)
fracture: with manipulation, with or without skeletal traction
Open treatment of proximal humeral (surgical or anatomical neck)
23615 fracture, with or without internal or external fixation, with/without repair 75 ‫يساهم الصندوق‬
of tuberosity(ies)
Open treatment of proximal humeral fracture, with or without internal or
23616 external fixation, with/without repair of tuberosity(ies): with proximal 115 ‫يساهم الصندوق‬
humeral prosthetic replacement
23625 Closed treatment of greater tuberosity fracture: with manipulation 20 ‫يساهم الصندوق‬
Open treatment of greater tuberosity fracture, with or without internal or
external fixation
23650 Closed treatment of shoulder dislocation, with manipulation 20 ‫يساهم الصندوق‬
23660 Open treatment of acute shoulder dislocation 40 ‫يساهم الصندوق‬
Closed treatment of shoulder dislocation, with fracture of greater
tuberosity, with manipulation
Open treatment of shoulder dislocation, with fracture of greater
tuberosity, with or without internal or external fixation
Closed treatment of shoulder dislocation, with surgical or anatomical
neck fracture, with manipulation
Open treatment of shoulder dislocation, with surgical or anatomical neck
fracture, with or without internal or external fixation
Manipulation under anesthesia, shoulder joint, including application of
fixation apparatus (dislocation excluded)
Arthrodesis, shoulder joint: with primary autogenous graft (includes
obtaining graft) or without local bone graft (separate procedure)
23900 Interthoracoscapular (forequarter) amputation of shoulder 115 ‫يساهم الصندوق‬
23920 Disarticulation of shoulder 85 ‫يساهم الصندوق‬
23921 Disarticulation of shoulder: secondary closure or scar revision 40 ‫يساهم الصندوق‬
Incision and drainage, upper arm or elbow area: deep abscess or
hematoma or infected bursa
abscess), humerus or elbow
Arthrotomy (capsulotomy), elbow, for infection, with exploration,
24000 drainage or removal of foreign body or capsular excision for capsular 35 ‫يساهم الصندوق‬
release
24065 Biopsy, soft tissue of upper arm or elbow area: superficial 15 ‫يساهم الصندوق‬
24066 Biopsy, soft tissue of upper arm or elbow area: deep 35 ‫يساهم الصندوق‬
24075 Excision, tumor, upper arm or elbow area: subcutaneous 35 ‫يساهم الصندوق‬
Radical resection of tumor (eg, malignant neoplasm), soft tissue of upper
arm or elbow area
Arthrotomy, elbow: with joint exploration, with or without synovial
biopsy, with or without removal of loose or foreign body
24102 Arthrotomy, elbow: for synovectomy 50 ‫يساهم الصندوق‬
24105 Excision,olecranon bursa 35 ‫يساهم الصندوق‬
24110 Excision or curettage of bone cyst or benign tumor, humerus 60 ‫يساهم الصندوق‬
Excision or curettage of bone cyst or benign tumor, humerus: with
autograft (includes obtaining graft) or with allograft
Excision or curettage of bone cyst or benign tumor of head or neck of
radius or olecranon process
Excision or curettage of bone cyst or benign tumor of head or neck of
24125 radius or olecranon process: with autograft (includes obtaining graft) or 50 ‫يساهم الصندوق‬
with allograft
24130 Excision, radial head 35 ‫يساهم الصندوق‬
Sequestrectomy (eg, for osteomyelitis or bone abscess), shaft or distal
humerus, radial head or neck, or olecranon process
Partial excision (craterization, saucerization or diaphysectomy) of bone
(eg, for osteomyelitis), humerus, radial head or neck, or olecranon process
24150 Radical resection for tumor, shaft or distal humerus 70 ‫يساهم الصندوق‬
Radical resection for tumor, shaft or distal humerus: with autograft
24152 Radical resection for tumor, radial head or neck 50 ‫يساهم الصندوق‬
Radical resection for tumor, radial head or neck: with autograft (includes
obtaining graft)
24155 Resection of elbow joint (arthrectomy) 70 ‫يساهم الصندوق‬
24160 Implant removal: elbow joint or radial head 35 ‫يساهم الصندوق‬
24200 Removal of foreign body, upper arm or elbow area: subcutaneous 15 ‫يساهم الصندوق‬
24201 Removal of foreign body, upper arm or elbow area: deep 35 ‫يساهم الصندوق‬
24220 Injection procedure for elbow arthrography 10 ‫يساهم الصندوق‬
24301 Muscle or tendon transfer, any type, upper arm or elbow, single 50 ‫يساهم الصندوق‬
24305 Tendon lengthening, upper arm or elbow, single, each 50 ‫يساهم الصندوق‬
24310 Tenotomy, open, elbow to shoulder, single, each 35 ‫يساهم الصندوق‬
Tenoplasty, with muscle transfer, with or without free graft, elbow to
shoulder, single
24330 Flexor-plasty, elbow 70 ‫يساهم الصندوق‬
24340 Tenodesis for rupture of biceps tendon at elbow 50 ‫يساهم الصندوق‬
Reinsertion of ruptured biceps tendon, distal, with or without tendon graft
Fasciotomy, lateral or medial (eg,tennis elbow epycondilitis) with or
without extensor origin detachment
Fasciotomy, lateral or medial (eg,tennis elbow epycondilitis) with annular
ligament resection, stripping or partial ostectomy
24360 Arthroplasty, elbow: with membrane, or with distal humeral replacement 70 ‫يساهم الصندوق‬
Arthroplasty, elbow: with implant and fascia lata ligament reconstruction
24362 or with distal humerus and proximal ulnar prosthetic replacement (total 125 ‫يساهم الصندوق‬
elbow)
24366 Arthroplasty, radial head: with or without implant 50 ‫يساهم الصندوق‬
24400 Osteotomy, humerus, with or without internal fixation 65 ‫يساهم الصندوق‬
Multiple osteotomies with realignment on intramedullary rod, humeral
shaft (Sofield type procedure)
24420 Osteoplsty, humerus, shortening or lengthening 100 ‫يساهم الصندوق‬
Repair of nonunion or malunion, humerus: without graft (eg, compression
technique)
Repair of nonunion or malunion, humerus: with iliac or other autograft
24470 Hemiepiphyseal arrest (eg, for cubitus varus or valgus, distal humerus) 50 ‫يساهم الصندوق‬
24495 Decompression fasciotomy, forearm, with brachial artery exploration 50 ‫يساهم الصندوق‬
Prophylactic treatment (nailing, pinning, plating or wiring) with or
without methyl methacrylate, humerus (open procedure)
Closed treatment of humeral shaft fracture: with manipulation, with or
without skeletal traction
Open treatment of humeral shaft fracture, with insertion of intramedullary
implant, with or without cerclage and/or locking screws
Closed treatment of supracondylar or transcondylar humeral fracture,
24535 with manipulation, with or without skin or skeletal traction or 35 ‫يساهم الصندوق‬
manipulation
Percutaneous skeletal fixation of supracondylar or transcondylar humeral
fracture, with or without intercondylar extension
Open treatment of humeral supracondylar or transcondylar fracture, with
or without internal or external fixation: without intercondylar extension
Open treatment of humeral supracondylar or transcondylar fracture, with
or without internal fixation: with intercondylar extension
Closed treatment of humeral epicondylar fracture, medial or lateral: with
manipulation
Open treatment of humeral epicondylar fracture, medial or lateral, with or
without internal or external skeletal fixation
Closed treatment of humeral condylar fracture, medial or lateral: with or
without manipulation
Open treatment of humeral condylar fracture, medial or lateral, with or
without internal or external fixation
Open treatment of periarticular fracture and/or dislocation of the elbow
(fracture distal humerus and proximal ulna and/or proximal radius)
Open treatment of periarticular fracture and/or dislocation of the elbow
24587 (fracture distal humerus and proximal ulna and/or proximal radius): with 100 ‫يساهم الصندوق‬
implant arthroplasty
24600 Treatment of closed elbow dislocation 35 ‫يساهم الصندوق‬
24615 Open treatment of acute or chronic elbow dislocation 50 ‫يساهم الصندوق‬
Closed treatment of Monteggia type of fracture dislocation at elbow
24620 (fracture proximal end of ulna with dislocation of radial head), with 35 ‫يساهم الصندوق‬
manipulation
Open treatment of Monteggia type of fracture dislocation at elbow
24635 (fracture proximal end of ulna with dislocation of radial head), with or 75 ‫يساهم الصندوق‬
Closed treatment of radial head subluxation in child (nursemaid elbow),
with manipulation
24655 Closed treatment of radial head or neck fracture: with manipulation 35 ‫يساهم الصندوق‬
Open treatment of radial head or neck fracture, with or without internal
fixation or radial head excision or with radial head prosthetic implant
Closed treatment of ulnar fracture, proximal end (olecranon process):
with manipulation
Open treatment of ulnar fracture proximal end (olecranon process), with
or without internal or external fixation
Arthrodesis, elbow joint: with or without autograft or allograft (includes
obtaining graft other than locally obtained) separate procedure)
24900 Amputation, arm through humerus 50 ‫يساهم الصندوق‬
24925 Amputation, arm through humerus: secondary closure or scar revision 35 ‫يساهم الصندوق‬
24931 Amputation, arm through humerus: with implant 70 ‫يساهم الصندوق‬
24935 Stump elongation, upper extremity 100 ‫يساهم الصندوق‬
24940 Cineplasty, upper extremity, complete procedure 50 ‫يساهم الصندوق‬
25000 Tendon sheath incision: at radial styloid , eg for de Quervain's disease 25 ‫يساهم الصندوق‬
Tendon sheath incision: at wrist for stenosing tenosynovitis, with
synovectomy
Decompression fasciotomy, forearm and/or wrist: flexor and/or extensor
25020 compartment, with or without debridement of non viable muscle and/or 35 ‫يساهم الصندوق‬
nerve
Incision and drainage, forearm and/or wrist: deep abscess or hematoma or
infected bursa
abscess), forearm and/or wrist
Arthrotomy, radiocarpal or mediocarpal joint, for infection, with
exploration, drainage, or removal of foreign body
Biopsy, soft tissue of forearm and/or wrist: superficial (separate
procedure)
25066 Biopsy, soft tissue of forearm and/or wrist: deep (separate procedure) 25 ‫يساهم الصندوق‬
25075 Excision, tumor, forearm and/or wrist area (superficial) 25 ‫يساهم الصندوق‬
Excision, tumor , forearm and/or wrist area: deep, subfascial or
intramuscular
Radical resection of tumor (eg, malignant neoplasm), soft tissue of
forearm and/or wrist area
25085 Capsulotomy, wrist (eg, for contracture) 25 ‫يساهم الصندوق‬
Arthrotomy, wrist joint: with exploration, with or without biopsy, with or
without removal of loose or foreign body
25105 Arthrotomy, wrist joint: for synovectomy 45 ‫يساهم الصندوق‬
Arthrotomy, distal radioulnar joint for repair of triangular cartilage
complex
25110 Excision, lesion of tendon sheath, forearm and/or wrist 25 ‫يساهم الصندوق‬
25111 Excision of ganglion, wrist (dorsal or volar) 25 ‫يساهم الصندوق‬
Radical excision of bursa, synovia of wrist, or forearm tendon sheaths;
flexors or extensors, with or without transposition of dorsal retinaculum
25118 Synovectomy, extensor tendon sheath, wrist, single compartment 30 ‫يساهم الصندوق‬
Synovectomy, extensor tendon sheath, wrist, single compartment: with
resection of distal ulna
Excision or curettage of bone cyst or benign tumor of radius or ulna
(excluding head or neck of radius and olecranon process)
Excision or curettage of bone cyst or benign tumor of radius or ulna
25125 (excluding head or neck of radius and olecranon process): with autograft 50 ‫يساهم الصندوق‬
(includes obtaining graft) or with allograft
25130 Excision or curettage of bone cyst or benign tumor of carpal bones 35 ‫يساهم الصندوق‬
Excision or curettage of bone cyst or benign tumor of carpal bones: with
autograft (includes obtaining graft) or with allograft
Partial excision (craterization, saucerization or diaphysectomy) of bone,
25150 or sequestrectomy (eg, for osteomyelitis or bone abscess), forearm and/or 45 ‫يساهم الصندوق‬
wrist
25170 Radical resection for tumor, radius or ulna 70 ‫يساهم الصندوق‬
25215 Carpectomy: all bones of proximal row 45 ‫يساهم الصندوق‬
25230 Radial styloidectomy (separate procedure) 35 ‫يساهم الصندوق‬
25240 Excision distal ulna (Darrach type procedure) 35 ‫يساهم الصندوق‬
25246 Injection procedure for wrist arthrography 15 ‫يساهم الصندوق‬
25248 Exploration for removal of deep foreign body, forearm or wrist 25 ‫يساهم الصندوق‬
25250 Removal of wrist prosthesis: (separate procedure) 35 ‫يساهم الصندوق‬
25251 Removal of wrist prosthesis: complicated, including total wrist 60 ‫يساهم الصندوق‬
Repair, tendon or muscle, flexor, forearm and/or wrist: primary or
secondary, single, each tendon or muscle
Repair, tendon or muscle, flexor, forearm and/or wrist: secondary, with
free graft (includes obtaining graft), each tendon or muscle
Repair, tendon or muscle, extensor, forearm and/or wrist: primary or
secondary, single, each tendon or muscle
Repair, tendon or muscle, extensor, secondary, with tendon graft
(includes obtaining grat), forearm and/or wrist, each tendon or muscle
Lengthening or shortening of flexor or extensor tendon, forearm and/or
wrist, single, each tendon
Tenotomy, open, flexor or extensor tendon, forearm and/or wrist, single,
each tendon
Tenolysis, flexor or extensor tendon, forearm and/or wrist, single, each
tendon
25300 Tenodesis at wrist: flexors or extensors of fingers 55 ‫يساهم الصندوق‬
Tendon transplantation or transfer, flexor or extensor, forearm and/or
wrist, single: each tendon
Tendon transplantation or transfer, flexor or extensor, foream and/or
wrist, single: with tendon graft(s) (includes obtaining graft), each tendon
Flexor origin slide (eg, for cerebral palsy, Volkmann contracture) forearm
and/or wrist
Flexor origin slide for cerebral palsy, forearm and/or wrist: with
tendon(tendons) transfer
Capsulorrhaphy or reconstruction, capsulectomy, wrist, (includes
synovectomy, resection of capsule, tendon insertions)
Arthroplasty, wrist, with or without interposition, with or without
external or internal fixation
25335 Centralization of wrist on ulna (eg, radial club hand) 75 ‫يساهم الصندوق‬
25350 Osteotomy, radius or ulna 60 ‫يساهم الصندوق‬
25365 Osteotomy: radius and ulna 70 ‫يساهم الصندوق‬
Multiple osteotomies, with realignment on intramedullary rod (Sofield
type procedure): radius AND/OR ulna
25390 Osteoplasty, radius OR ulna: shortening 70 ‫يساهم الصندوق‬
25391 Osteoplasty, radius OR ulna: lengthening with autograft 75 ‫يساهم الصندوق‬
25392 Osteoplasty, radius AND ulna: shortening (excluding 64876) 90 ‫يساهم الصندوق‬
25393 Osteoplasty, radius AND ulna: lengthening with autograft 100 ‫يساهم الصندوق‬
Repair of nonunion or malunion, radius OR ulna: without graft (eg,
compression technique)
Repair of nonunion or malunion, radius OR ulna: with iliac or other
autograft (includes obtaining graft)
Repair of nonunion or malunion, radius AND ulna: with iliac or other
autograft (includes obtaining graft)
25425 Repair of defect with autograft: radius OR ulna 75 ‫يساهم الصندوق‬
25426 Repair of defect with autograft: radius AND ulna 100 ‫يساهم الصندوق‬
Repair of nonunion, scaphoid (navicular) bone, with or without radial
styloidectomy (includes obtaining graft and necessary fixation)
25441 Arthroplasty with prosthetic replacement: distal radius 85 ‫يساهم الصندوق‬
Arthroplasty with prosthetic replacement: distal ulna, scaphoid, lunate or
trapezium
Arthroplasty with prosthetic replacement: distal radius and partial or
entire carpus (total wrist)
25447 Interposition arthroplasty, intercarpal or carpometacarpal joints 70 ‫يساهم الصندوق‬
25449 Revision of arthroplasty, including removal of implant, wrist joint 60 ‫يساهم الصندوق‬
Epiphyseal arrest by epiphysiodesis or stapling: distal radius AND/OR
ulna
without methyl methacrylate: radius or ulna
Prophylactic treatment (nailing, pinning, plating or wiring ) with or
without methyl methacrylate: ulna (open procedure)
without methyl methacrylate: radius AND ulna (open procedure)
25505 Closed treatment of radial shaft fracture: with manipulation 30 ‫يساهم الصندوق‬
Open treatment of radial shaft fracture: with/without internal or external
fixation
Closed treatment of radial shaft fracture, with dislocation of distal
radioulnar joint (Galeazzi fracture/dislocation)
Open treatment of radial shaft fracture, with internal and/or external
fixation, and closed treatment of dislocation of distal radioulnar joint
(Galeazzi fracture/dislocation), with or without percutaneous skeletal
fixation
Open treatment of radial shaft fracture, with internal and/or external
fixation, with or without internal or external fixation of distal radioulnar
joint, includes repair of triangular cartilage, with or without percutaneous
skeletal fixation
25535 Closed treatment of ulnar shaft fracture: with manipulation 25 ‫يساهم الصندوق‬
Open treatment of ulnar shaft fracture: with/without internal or external
fixation
25565 Closed treatment of radial and ulnar shaft fractures: with manipulation 35 ‫يساهم الصندوق‬
Open treatment of radial and ulnar shaft fractures, with internal or
external fixation of radius or ulna
Open treatment of radial and ulnar shaft fractures, with internal or
external fixation: of radius and ulna
Closed treatment of distal radial fracture (Colles or Smith type) or
25605 epiphyseal separation, with or without fracture of ulnar styloid: with 35 ‫يساهم الصندوق‬
manipulation
Percutaneous skeletal fixation of distal radial fracture or epiphyseal
25611 separation, with or without fracture of ulnar styloid, requiring 40 ‫يساهم الصندوق‬
manipulation, with or without external fixation
Open treatment of distal radial fracture, or epiphyseal separation, with or
25620 without fracture of ulnar styloid, with or without internal or external 60 ‫يساهم الصندوق‬
fixation
Closed treatment of carpal scaphoid (navicular) fracture: with
manipulation
Open treatment of carpal scaphoid (navicular) fracture, with or without
internal or external fixation
Closed treatment of carpal bone fracture excluding carpal scaphoid
(navicular): with manipulation, each bone
Open treatment of carpal bone fracture (excluding carpal scaphoid
(navicular)), each bone
Closed treatment of radiocarpal or intercarpal dislocation, one or more
bones, with manipulation
Open treatment of radiocarpal or intercarpal dislocation, one or more
bones
25675 Closed treatment of distal radioulnar dislocation with manipulation 25 ‫يساهم الصندوق‬
25676 Open treatment of distal radioulnar dislocation, acute or chronic 35 ‫يساهم الصندوق‬
Closed treatment of trans-scaphoperilunar type of fracture dislocation,
with manipulation
25685 Open treatment of trans-scaphoperilunar type of fracture dislocation 60 ‫يساهم الصندوق‬
25690 Closed treatment of lunate dislocation, with manipulation 25 ‫يساهم الصندوق‬
25695 Open treatment of lunate dislocation 45 ‫يساهم الصندوق‬
Arthrodesis, wrist joint (including radiocarpal and/or ulnocarpal fusion):
without bone graft (separate procedure)
Arthrodesis, wrist joint (including radiocarpal and/or ulnocarpal fusion):
25805 with sliding graft or iliac or other autograft (includes obtainig graft) 75 ‫يساهم الصندوق‬
separate procedure)
Intercarpal fusion: with autograft (includes obtaining graft) or bone graft
Amputation or reamputation, forearm through radius and ulna: closed or
open circular
25907 Amputation, forearm: secondary closure or scar revision 35 ‫يساهم الصندوق‬
25915 Krukenberg procedure 75 ‫يساهم الصندوق‬
25922 Disarticulation through wrist or secondary closure or scar revision 35 ‫يساهم الصندوق‬
25929 Transmetacarpal amputation or secondary closure or scar revision 35 ‫يساهم الصندوق‬
26010 Drainage of finger abscess 10 ‫يساهم الصندوق‬
26020 Drainage of tendon sheath, one digit and/or palm 25 ‫يساهم الصندوق‬
26025 Drainage of palmar bursa 30 ‫يساهم الصندوق‬
abscess), hand or finger
26035 Decompression fingers and/or hand, injection injury (eg, grease gun) 45 ‫يساهم الصندوق‬
26037 Decompressive fasciotomy, hand 35 ‫يساهم الصندوق‬
26040 Fasciotomy, palmar, for Dupuytren's contracture: closed (subcutaneous) 35 ‫يساهم الصندوق‬
26045 Fasciotomy, palmar, for Dupuytren's contracture: open, partial 35 ‫يساهم الصندوق‬
26055 Tendon sheath incision for trigger finger 25 ‫يساهم الصندوق‬
26060 Tenotomy, subcutaneous, single, each digit 15 ‫يساهم الصندوق‬
Arthrotomy, with exploration, drainage or removal of foreign body:
carpometacarpal, metacarpophalangeal or interphalangeal joint, each joint
Arthrotomy for synovial biopsy: carpometacarpal or metacarpophalangeal
or interphalangeal joint
26115 Excision, tumor or vascular malformation, hand or finger, subcutaneous 25 ‫يساهم الصندوق‬
Excision, tumor or vascular malformation, hand or finger: deep,
subfascial intramuscular
hand or finger
Fasciectomy, palmar only, with or without z-plasty, other local tissue
rearrangement, or skin grafting (includes obtaining graft)
Fasciectomy, partial palmar with release of single digit including
26123 proximal interphalangeal joint, with or without Z-plasty, other local tissue 60 ‫يساهم الصندوق‬
rearrangement, or skin grafting (includes obtaining the graft)
Fasiectomy, partial palmar with release of single digit including proximal
interphalageal joint, with/without Z-plasty, other local tissue
rearrangement, or skin grafting (includes obtaining graft): each additional
digit (list separately in addition
26130 Synovectomy, carpometacarpal joint 40 ‫يساهم الصندوق‬
Synovectomy, metacarpophalangeal joint including intrinsic release and
extensor hood reconstruction, each digit
Synovectomy, proximal interphalangeal joint, including extensor
reconstruction, each interphalangeal joint
Synovectomy tendon sheath, radical (tenosynovectomy), flexor, palm or
finger, single, each digit
Excision of lesion of tendon sheath or capsule (eg, cyst or ganglion),
hand or finger
Excision of tendon, palm or finger, flexor, single (separate procedure),
each
Excision or curettage of bone cyst or benign tumor of metacarpal or
phalanges
Excision or curettage of bone cyst or benign tumor of metacarpal or
phalanges: with autograft (includes obtaining graft)
Excision or curettage of bone cyst or benign tumor of proximal, middle or
distal phalanx of finger
Excision or curettage of bone cyst or benign tumor of proximal, middle or
distal phalanx of finger: with autograft (includes obtaining graft)
26235 (eg, for osteomyelitis): metacarpal or proximal, middle or distal phalanx 40 ‫يساهم الصندوق‬
of finger
Radical resection (ostectomy) for tumor, metacarpal or proximal or
middle phalanx of finger: with autograft (includes obtaining graft)
Radical resection (ostectomy) for tumor, proximal or middle or distal
phalanx of finger or metacarpal
26263 Radical resection of interphalangeal joint, with internal skeletal fixation 70 ‫يساهم الصندوق‬
26320 Removal of implant from finger or hand 25 ‫يساهم الصندوق‬
Flexor tendon repair or advancement, single, not in no man's land primary
or secondary without free graft,each tendon
Flexor tendon repair or advancement, single, not in no man's land
secondary,with the graft(includes obtaining graft),each tendon
Flexor tendon repair or advancement, single, in no man's land primary
each tendon
Flexor tendon repair or advancement,single, in no man's land secondary
each tendon
Flexor tendon repair or advancement, single, in no man's land secondary
with free graft (includes obtaining graft) each tendon
26370 Profundus tendon repair or advancement, with intact sublimis: primary 40 ‫يساهم الصندوق‬
Profundus tendon repair or advancement, with intact sublimis: secondary
with free graft (includes obtaining graft)
Profundus tendon repair or advancement, with intact sublimis: secondary
without free graft
Flexor tendon excision, implantation of plastic tube or rod for delayed
tendon graft, hand or finger
Removal of tube or rod and insertion of flexor tendon graft (includes
obtaining graft), hand or finger
Extensor tendon repair, dorsum of hand, single, primary or secondary:
without free graft, each tendon
Extensor tendon repair, dorsum of hand, single, primary or secondary:
with free graft (includes obtaining graft), each tendon
Extensor tendon excision, implantation of plastic tube or rod for delayed
extensor tendon graft, hand or finger
Removal of tube or rod and insertion of extensor tendon graft (includes
obtaining graft), hand or finger
Extensor tendon repair, dorsum of finger, single, primary or secondary:
Extensor tendon repair, dorsum of finger, single, primary or secondary:
with free graft (includes obtaining graft), each tendon
Extensor tendon repair, central slip repair, secondary (boutonni‫ك‬re
deformity): using local tissue
Extensor tendon repair, central slip repair, secondary (boutonni‫ك‬re
deformity): with free graft (includes obtaining graft)
Extensor tendon repair, distal insertion (mallet finger) closed, splinting
with or withour percutaneous pinning
Extensor tendon repair, distal insertion (mallet finger),open,primary or
secondary,repair,without graft
Extensor tendon repair, distal insertion (mallet finger),open,primary or
secondary repair with free graft (includes obtaining graft)
26437 Extensor tendon realignment, hand 40 ‫يساهم الصندوق‬
26440 Tenolysis, simple, flexor tendon: palm OR finger, single, each tendon 30 ‫يساهم الصندوق‬
26442 Tenolysis, simple, flexor tendon: palm AND finger, each tendon 50 ‫يساهم الصندوق‬
26445 Tenolysis, extensor tendon, dorsum of hand or finger: each tendon 30 ‫يساهم الصندوق‬
Tenolysis, complex, extensor tendon, dorsum of hand or finger, including
hand and forearm
26450 Tenotomy, flexor, single, palm or finger, open, each 25 ‫يساهم الصندوق‬
26460 Tenotomy, extensor, hand or finger, single, open, each 25 ‫يساهم الصندوق‬
26471 Tenodesis: for proximal or distal interphalangeal joint stabilization 40 ‫يساهم الصندوق‬
Tendon lengthening or shortening, extensor or flexor, hand or finger,
single, each tendon
Tendon transfer or transplant, carpometacarpal area or dorsum of hand,
26483 single: with or without free tendon graft (includes obtaining graft), each 55 ‫يساهم الصندوق‬
tendon
Tendon transfer or transplant, palmar, single, each tendon: without free
tendon graft
Tendon transfer or transplant, palmar, single, each tendon: with free
tendon graft (includes obtaining graft)
26490 Opponens plasty: tendon transfer, any type 50 ‫يساهم الصندوق‬
Opponens plasty: tendon transfer with graft (includes obtaining graft) or
hypothenar muscle transfer
26497 Tendon transfer to restore intrinsic function: ring and small finger 60 ‫يساهم الصندوق‬
26498 Tendon transfer to restore intrinsic function: all four fingers 95 ‫يساهم الصندوق‬
26499 Correction claw finger, other methods 60 ‫يساهم الصندوق‬
26500 Tendon pulley reconstruction: with local tissues (separate procedure) 40 ‫يساهم الصندوق‬
Tendon pulley reconstruction: with tendon or fascial graft (includes
obtaining graft) or tendon prosthesis (separate procedure)
26508 Thenar muscle release for thumb contracture 40 ‫يساهم الصندوق‬
26510 Cross intrinsic transfer 40 ‫يساهم الصندوق‬
26516 Capsulodesis for M-P joint stabilization: single or two digit 40 ‫يساهم الصندوق‬
26518 Capsulodesis for M-P joint stabilization: three or four digits 60 ‫يساهم الصندوق‬
Capsulectomy or capsulotomy for contracture: metacarpophalangeal joint
or interphalangeal joint, single, each joint
Arthroplasty, metacarpophalangeal joint or interphalangeal joint: single
joint
Arthroplasty, metacarpophalangeal joint or interphalangeal joint: with
prosthetic implant, single joint
Reconstruction, collateral ligament, metacarpophalangeal joint, single,
with tendon or fascial graft (includes obtaining graft)
Reconstruction collateral ligament, metacarpophalangeal joint, with local
tissue (eg, adductor advancement)
Reconstruction, collateral ligament, interphalangeal joint, single,
including graft, each joint
26548 Repair and reconstruction, finger, volar plate, interphalangeal joint 55 ‫يساهم الصندوق‬
26550 Pollicization of a digit 100 ‫يساهم الصندوق‬
Toe-to-hand transfer with microvascular anastomosis: great toe "wrap
around" with bone graft(includes obtaining graft)
26555 Positional change of other finger 110 ‫يساهم الصندوق‬
26556 Free toe joint transfer with microvascular anastomosis 270 ‫يساهم الصندوق‬
26560 Repair of syndactyly (web finger) each web space: with skin flaps 45 ‫يساهم الصندوق‬
Repair of syndactyly (web finger) each web space: with skin flaps and
grafts and/or involving bone, nails
26565 Osteotomy for correction of deformity: metacarpal or phalanx of finger 50 ‫يساهم الصندوق‬
26568 Osteoplasty for lengthening of metacarpal or phalanx 55 ‫يساهم الصندوق‬
26580 Repair cleft hand 60 ‫يساهم الصندوق‬
26585 Repair bifid digit 60 ‫يساهم الصندوق‬
26587 Reconstruction of supernumerary digit, soft tissue and bone 90 ‫يساهم الصندوق‬
26590 Repair macrodactylia 150 ‫يساهم الصندوق‬
26591 Repair or release, intrinsic muscles of hand (specify) 40 ‫يساهم الصندوق‬
26596 Excision of constricting ring of finger, with multiple z-plasties 50 ‫يساهم الصندوق‬
Release of scar contracture, flexor or extensor, with skin grafts,
rearrangement flaps, or z-plasties, hand and/or finger
Closed tretament of metacarpal fracture, single: with manipulation, each
bone
Closed treatment of metacarpal fracture, with manipulation, with internal
or external fixation, each bone
Open treatment of metacarpal fracture, single, with or without internal or
external fixation, each bone
Closed treatment of carpometacarpal dislocation, thumb, with
manipulation
Closed treatment of carpometacarpal or metacarpophalangeal fracture
dislocation (Bennett fracture) single, with manipulation
Percutaneous skeletal fixation of carpometacarpal or
26650 metacarpophalangeal fracture dislocation, thumb (Bennett fracture), with 40 ‫يساهم الصندوق‬
manipulation: with or without external fixation
Open treatment of carpometacarpal fracture dislocation thumb (Bennett
fracture), with or without internal or external fixation
Percutaneous skeletal fixation of carpometacarpal dislocation, other than
thumb (Bennett fracture), single, with manipulation
Open treatment of carpometacarpal dislocation, other than thumb
(Bennett fracture): single, with or without internal or external fixation
Open treatment of carpometacarpal dislocation, other than thumb
(Bennett fracture): complex, multiple or delayed reduction
Closed treatment of metacarpophalngeal dislocation, single, with
manipulation
Percutaneous skeletal fixation of metacarpophalangeal dislocation, single,
with manipulation
Open treatment of metacarpophalangeal dislocation, single, with or
Closed treatment of phalangeal shaft fracture, proximal or middle
26725 phalanx, finger or thumb, with manipulation, with or without skin or 20 ‫يساهم الصندوق‬
skeletal traction, each
Percutaneous skeletal fixation of unstable phalangeal shaft fracture,
proximal or middle phalanx, finger or thumb, with manipulation, each
Open treatment of phalangeal shaft fracture, proximal or middle phalanx,
finger or thumb, with or without internal or external fixation, each
Closed treatment of articular fracture, involving metacarpophalangeal or
interphalangeal joint: with manipulation, each
Open treatment of articular fracture, involving metacarpophalangeal or
interphalangeal joint, with or without internal or external fixation, each
Closed treatment of distal phalangeal fracture, finger or thumb, with
manipulation, each
Percutaneous skeletal fixation of distal phalangeal fracture, finger or
thumb, each
Open treatment of distal phalangeal fracture, finger or thumb, with or
without internal or external fixation, each
Closed treatment of interphalangeal joint dislocation, single, with
manipulation
Percutaneous skeletal fixation of interphalangeal joint dislocation, single,
with manipulation
Open treatment of interphalangeal joint dislocation, with or without
internal or external fixation, single
Fusion in opposition, thumb, with autogenous graft (includes obtaining
graft) (separate procedure)
Arthrodesis, carpometacarpal joint, any digit , with or without internal
fixation (separate procedure)
Arthrodesis, carpometacarpal joint, any digit, with or without internal
fixation: with autograft (includes obtaining graft) (separate procedure)
Arthrodesis, metacarpophalangeal joint, with or without internal fixation
Arthrodesis, metacarpophalangeal joint, with or without internal fixation:
with autograft (includes obtaining graft) (separate procedure)
Arthrodesis, interphalangeal joint, with or without internal fixation
Arthrodesis, interphalangeal joint, with or without internal fixation: each
additional joint
Arthrodesis, interphalangeal joint, with or without internal fixation, with
autograft (includes obtaining graft) (separate procedure)
Arthrodesis, interphalangeal joint, with or without internal fixation: with
autograft (includes obtaining graft), each additional digit
Amputation, metacarpal, with finger or thumb (ray amputation), single,
with or without interosseous transfer
Amputation, finger or thumb, primary or secondary, any joint or phalanx,
single, including neurectomies: with direct closure
Amputation, finger or thumb, primary or secondary, any joint or phalanx,
single, including neurectomies: with local advancement flaps (V-Y, hood)
Incision and drainage, pelvis or hip joint area: deep abscess or hematoma
or infected bursa
abscess), pelvis and/or hip joint
27000 Tenotomy, adductor of hip, subcutaneous, closed (separate procedure) 30 ‫يساهم الصندوق‬
Tenotomy, adductor of hip, subcutaneous, open, with or without obturator
neurectomy
27006 Tenotomy, iliopsoas or abductors of hip, open (separate procedure) 55 ‫يساهم الصندوق‬
27025 Fasciotomy, hip or thigh, any type 55 ‫يساهم الصندوق‬
Arthrotomy, hip, for infection with drainage for exploration or removal of
loose or foreign body
Hip joint denervation, intrapelvic or extrapelvic intra-articular branches
of sciatic, femoral or obturator nerves
Capsulectomy or capsulotomy of hip, with or without excision of
27036 heterotopic bone, with release of hip flexor muscles (ie, gluteus medius, 70 ‫يساهم الصندوق‬
gluteus minimus, tensor fascia latae, rectus femoris, sartorius, iliopsoas)
27040 Biopsy, soft tissue of pelvis and hip area: superficial 30 ‫يساهم الصندوق‬
27047 Excision, tumor, pelvis and hip area: subcutaneous 30 ‫يساهم الصندوق‬
Radical resection of tumor (eg, malignant neoplasm), soft tissue of pelvis
and hip area
27050 Arthrotomy, for biopsy: sacro-iliac joint 40 ‫يساهم الصندوق‬
27054 Arthrotomy for biopsy or synovectomy, hip joint 55 ‫يساهم الصندوق‬
27062 Excision, ischial or trochanteric bursa or calcification 40 ‫يساهم الصندوق‬
Excision of bone cyst or benign tumor: superficial (wing of ilium,
symphysis pubis, or greater trochanter of femur) with or without autograft
Excision of bone cyst or benign tumor, deep pelvis, with or without
autograft
Excision of bone cyst or benign tumor, pelvis: with autograft requiring
separate incision
Partial excision (craterization, saucerization) (eg, for osteomyelitis):
pelvis
Radical resection for tumor or infection: ilium, including acetabulum,
pubic rami, or ischium and acetabulum
27077 Radical resection for tumor or infection: innominate bone, total 120 ‫يساهم الصندوق‬
Radical resection for tumor or infection: ischial tuberosity and greater
trochanter of femur, with or without skin flaps
27080 Coccygectomy, primary 40 ‫يساهم الصندوق‬
27086 Removal of foreign body, pelvis or hip, superficial 20 ‫يساهم الصندوق‬
27087 Removal of foreign body, pelvis or hip, deep 45 ‫يساهم الصندوق‬
27090 Removal of hip prosthesis (separate procedure) 50 ‫يساهم الصندوق‬
Removal of hip prosthesis: complicated, including total hip and methyl
methacrylate when applicable
27093 Injection procedure for hip arthrography 15 ‫يساهم الصندوق‬
27097 Hamstring recession, proximal 50 ‫يساهم الصندوق‬
27098 Adductor transfer to ischium 50 ‫يساهم الصندوق‬
Transfer external oblique muscle to greater trochanter including fascial or
tendon extension (graft)
Transfer paraspinal muscle to hip (includes fascial or tendon extension
graft)
27110 Transfer iliopsoas: to greater trochanter or femoral neck 70 ‫يساهم الصندوق‬
27120 Acetabuloplasty: (eg, Colonna, Whitman, Haygroves, or cup type) 105 ‫يساهم الصندوق‬
27122 Acetabuloplasty: resection femoral head (Girdlestone procedure) 75 ‫يساهم الصندوق‬
Partial hip replacement, prosthesis (eg, femoral stem prosthesis, bipolar
arthroplasty)
Arthroplasty, acetabular and proximal femoral prosthetic replacement
(total hip replacement), with or without autograft or allograft
Conversion of previous hip surgery to total hip replacement, with or
without autograft or allograft
Revision of total hip arthroplasty: both components, with or without
autograft or allograft
Revision of total hip arthroplasty: acetabular or femoral component only,
with or without autograft or allograft
27140 Osteotomy and transfer of greater trochanter (separate procedure) 70 ‫يساهم الصندوق‬
27146 Osteotomy, iliac, acetabular or innominate bone 100 ‫يساهم الصندوق‬
Osteotomy, iliac, acetabular or innominate bone: with open reduction of
hip and/or femoral osteotomy
27151 Osteotomy, iliac, acetabular or innominate bone: with femoral osteotomy 135 ‫يساهم الصندوق‬
27158 Osteotomy, pelvis, bilateral for congenital malformation 105 ‫يساهم الصندوق‬
27161 Osteotomy, femoral neck (separate procedure) 100 ‫يساهم الصندوق‬
Osteotomy, intertrochanteric or subtrochanteric including internal or
external fixation and/or cast
Bone graft, femoral head, neck, intertrochanteric or subtrochanteric area
27175 Treatment of slipped femoral epiphysis: by traction, without reduction 30 ‫يساهم الصندوق‬
Treatment of slipped femoral epiphysis: by single or multiple pinning, in
situ
Open treatment of slipped femoral epiphysis: single or multiple pinning
or bone graft (includes obtaining graft)
Open treatment of slipped femoral epiphysis: osteoplasty of femoral neck
(Heyman type procedure)
Open treatment of slipped femoral epiphysis: osteotomy and internal
fixation
27185 Epiphyseal arrest by epiphysiodesis or stapling, greater trochanter 50 ‫يساهم الصندوق‬
without methyl methacrylate, femoral neck and proximal femur
27202 Open treatment of coccygeal fracture 50 ‫يساهم الصندوق‬
Percutaneous skeletal fixation of posterior pelvic ring fracture and/or
dislocation (includes ilium, sacroiliac joint and/or sacrum)
Open treatment of anterior ring fracture and/or dislocation, with internal
fixation (includes pubis symphysis and/or rami)
Open treatment of posterior ring fracture and/or dislocation, with internal
fixation (includes ilium, sacroiliac joint and/or sacrum)
Closed treatment of acetabulum (hip socket) fracture(s): with
manipulation with or without skeletal traction
Open treatment of acetabular fracture(s) involving anterior and posterior
(two) columns, includes T-fracture and both column fracture with
27228 NULL ‫يساهم الصندوق‬
complete articular detachment, or single column or transverse fracture
with associated acetabular
Closed treatment of femoral fracture, proximal end, neck: without
manipulation
Closed treatment of femoral fracture, proximal end, neck: with
manipulation, with or without skeletal traction
Percutaneous skeletal fixation of femoral fracture, proximal end, neck,
undisplaced, mildly displaced or impacted fracture
Open treatment of femoral fracture, proximal end, neck, internal fixation
or prosthetic replacement (direct fracture exposure)
Closed treatment of intertrochanteric, pertrochanteric, or subtrochanteric
27240 femoral fracture, with manipulation: with or without skin or skeletal 50 ‫يساهم الصندوق‬
traction
Open treatment of intertrochanteric, pertrochanteric, or subtrochanteric
femoral fracture: with plate/screw type implant, with or without cerclage
Open treatment of intertrochanteric, pertrochanteric or subtrochanteric
27245 femoral fracture: with intramedullary implant, with or without 100 ‫يساهم الصندوق‬
interlocking screws and/or cerclage
Open treatment of greater trochanteric fracture, with or without internal
or external fixation
27250 Closed treatment of hip dislocation, traumatic 30 ‫يساهم الصندوق‬
27253 Open treatment of hip dislocation, traumatic, without internal fixation 70 ‫يساهم الصندوق‬
Open treatment of hip dislocation, traumatic, with acetabular wall and
femoral head fracture, with or without internal or external fixation
Treatment of spontaneous hip dislocation (developmental, including
27257 congenital or pathological),by abduction, splint or traction: with 30 ‫يساهم الصندوق‬
manipulation requiring anesthesia
Open treatment of spontaneous hip dislocation (developmental, including
27258 congenital or pathological): replacement of femoral head in acetabulum 100 ‫يساهم الصندوق‬
(including tenotomy, etc) and/or femoral shaft shortening
27265 Closed treatment of post hip arthroplasty dislocation 30 ‫يساهم الصندوق‬
27275 Manipulation hip joint, requiring general anesthesia 10 ‫يساهم الصندوق‬
Arthrodesis, sacroiliac joint or symphysis pubis (including obtaining
graft) (separate procedure)
Arthrodesis, hip joint (includes obtaining graft): with or without
subtrochanteric osteotomy (separate procedure)
27290 Hind quarter amputation 145 ‫يساهم الصندوق‬
27295 Disarticulation of hip 95 ‫يساهم الصندوق‬
Incision and drainage of deep abscess or bone cortex, infected bursa, or
hematoma, thigh, femur or knee region
27305 Fasciotomy, ilio-tibial, open 35 ‫يساهم الصندوق‬
Tenotomy, subcutaneous, closed, adductor or hamstring, (separate
procedure): single
Tenotomy, subcutaneous, closed, adductor or hamstring, (separate
procedure): multiple
Arthrotomy, knee, for infection, with exploration, drainage or removal of
foreign body
27320 Neurectomy, popliteal (gastrocnemius) or hamstring muscle 35 ‫يساهم الصندوق‬
27323 Biopsy, soft tissue of thigh or knee area 15 ‫يساهم الصندوق‬
27328 Excision, tumor, thigh or knee area: deep, subfascial, or intramuscular 35 ‫يساهم الصندوق‬
Radical resection of tumor (eg, malignant neoplasm), soft tissue of thigh
or knee area
Arthrotomy, knee: with joint exploration, with or without synovial
biopsy, with or without removal of loose or foreign bodies
27332 Arthrotomy, knee, for meniscectomy: medial OR lateral 55 ‫يساهم الصندوق‬
27333 Arthrotomy, knee, for meniscectomy: medial AND lateral 60 ‫يساهم الصندوق‬
Arthrotomy, knee, for synovectomy: anterior AND/OR posterior
including popliteal area
27340 Excision, prepatellar bursa 35 ‫يساهم الصندوق‬
27345 Excision of synovial cyst of popliteal space (Baker's cyst) 45 ‫يساهم الصندوق‬
27350 Patellectomy or hemipatellectomy 55 ‫يساهم الصندوق‬
Excision or curettage of bone cyst or benign tumor of femur: with or
27357 without autograft (includes obtaining graft) or allograft with or without 65 ‫يساهم الصندوق‬
internal fixation
(eg, for osteomyelitis), femur, proximal tibia and/or fibula
27365 Radical resection for tumor, femur or knee, bone or knee 100 ‫يساهم الصندوق‬
27370 Injection procedure for knee arthrography 15 ‫يساهم الصندوق‬
27372 Removal of foreign body, deep, thigh region or knee area 35 ‫يساهم الصندوق‬
Suture of infrapatellar tendon: primary or secondary reconstruction,
including fascial or tendon graft
Suture of quadriceps or hamstring muscle rupture: primay or secondary
reconstruction, including fascial or tendon graft
27390 Tenotomy, open, hamstring, knee to hip: single 35 ‫يساهم الصندوق‬
27391 Tenotomy, open, hamstring, knee to hip: multiple, one leg 45 ‫يساهم الصندوق‬
27392 Tenotomy, open, hamstring, knee to hip: multiple, bilateral 55 ‫يساهم الصندوق‬
27393 Lengthening of hamstring tendon: single 35 ‫يساهم الصندوق‬
27394 Lengthening of hamstring tendon: multiple, one leg 55 ‫يساهم الصندوق‬
27395 Lengthening of hamstring tendon: multiple, bilateral 60 ‫يساهم الصندوق‬
27396 Transplant, hamstring tendon to patella: single 50 ‫يساهم الصندوق‬
27397 Transplant, hamstring tendon to patella: multiple 60 ‫يساهم الصندوق‬
27400 Tendon or muscle transfer, hamstrings to femur (Eggers type procedure) 55 ‫يساهم الصندوق‬
27403 Arthrotomy with open meniscus repair 60 ‫يساهم الصندوق‬
27405 Repair, primary, torn ligament and/or capsule, knee: collateral or cruciate 55 ‫يساهم الصندوق‬
Repair, primary, torn ligament and/or capsule, knee: collateral and
cruciate
Anterior tibial tubercle plasty for chondromalacia patellae (Maquet
procedure)
27422 Reconstruction for recurrent dislocating patella: any method 55 ‫يساهم الصندوق‬
27424 Reconstruction for recurrent dislocating patella: with patellectomy 55 ‫يساهم الصندوق‬
27425 Lateral retinacular release (any method) 35 ‫يساهم الصندوق‬
27427 Ligamentous reconstruction (augmentation), knee: extra-articular 55 ‫يساهم الصندوق‬
27428 Ligamentous reconstruction (augmentation), knee: intra-articular (open) 75 ‫يساهم الصندوق‬
Ligamentous reconstruction (augmentation), knee: intra-articular (open)
and extra-articular
27430 Quadriceps plasty (Bennett or Thompson type) 55 ‫يساهم الصندوق‬
27435 Capsulotomy, knee, posterior capsular release 55 ‫يساهم الصندوق‬
27437 Arthroplasty, patella: without prosthesis 55 ‫يساهم الصندوق‬
27438 Arthroplasty, patella: with prosthesis 60 ‫يساهم الصندوق‬
27440 Arthroplasty, knee, tibial plateau 55 ‫يساهم الصندوق‬
Arthroplasty, knee, tibial plateau: with debridement and partial
synovectomy
Arthroplasty, knee, femoral condyles or tibial plateaus: with or without
debridement and partial synovectomy
27445 Arthroplasty, knee, constrained prosthesis (eg, Walldius type) 95 ‫يساهم الصندوق‬
27446 Arthroplasty, knee condyle and plateau: medial OR lateral compartment 95 ‫يساهم الصندوق‬
Arthroplasty, knee condyle and plateau: medial AND lateral
compartments with or without patella resurfacing (total fee replacement)
27448 Osteotomy, femur, shaft or supracondylar: without fixation 60 ‫يساهم الصندوق‬
27450 Osteotomy, femur, shaft or supracondylar: with fixation 105 ‫يساهم الصندوق‬
Osteotomy, proximal tibia, including fibular excision or osteotomy
27455 (includes correction of genu varus or genu valgus): before or after 95 ‫يساهم الصندوق‬
epiphyseal closure
27466 Osteoplasty, femur: lengthening or shortening 95 ‫يساهم الصندوق‬
Osteoplasty, femur: combined lengthening and shortening with femoral
segment transfer
Repair, nonunion or malunion, femur, distal to head and neck: with or
without iliac or other autogenous bone graft (includes obtaining graft)
27475 Epiphyseal arrest by epiphysiodesis or stapling: distal femur 55 ‫يساهم الصندوق‬
27477 Epiphyseal arrest by epiphysiodesis or stapling: tibia and fibula, proximal 60 ‫يساهم الصندوق‬
Epiphyseal arrest by epiphysiodesis or stapling: combined, distal femur
and proximal tibia and fibula
Hemiepiphyseal arrest, distal femur or proximal leg (eg, genu varus or
valgus)
Revision of total knee arthroplasty, with or without allograft: one
component
Revision of total knee arthroplasty, with or without allograft: all
components
27488 Removal of knee prosthesis, including 95 ‫يساهم الصندوق‬
Decompression fasciotomy, thigh and/or knee, one compartment (flexor
27496 or extensor or adductor) with or without debridement of nonviable 35 ‫يساهم الصندوق‬
muscle and/or nerve
Decompression fasciotomy, thigh and/or knee, multiple compartments,
with or without debridement of nonviable muscle and/or nerve
Closed treatment of femoral shaft fracture: with manipulation, with or
without skin or skeletal traction
Closed treatment of supracondylar or transcondylar femoral fracture with
27503 or without intercondylar extension: with manipulation, with or without 55 ‫يساهم الصندوق‬
skin or skeletal traction
Open treatment of femoral shaft fracture, with or without external
fixation, with insertion of intramedullary implant, with or without
cerclage and/or locking screws, with or without plate/screws, with or
without cerclage
Percutaneous skeletal fixation of supracondylar or transcondylar femoral
fracture, with or without intercondylar extension
Closed treatment of femoral fracture, distal end, medial or lateral
condyle: with manipulation
Open treatment of femoral supracondylar or transcondylar fracture
without intercondylar extension, with internal fixation
Open treatment of femoral supracondylar or transcondylar fracture with
intercondylar extension, with internal fixation
Open treatment of femoral fracture, distal end, medial or lateral condyle,
with or without internal or external fixation
Closed treatment of distal femoral epiphyseal separation: with
manipulation, with or without skin or skeletal traction
Open treatment of distal femoral epiphyseal separation, with or without
Open treatment of patellar fracture, with internal fixation and/or partial or
complete patellectomy and soft tissue repair
Closed treatment of tibial fracture, proximal (plateau): with or without
manipulation, with skeletal traction
Open treatment of tibial fracture, proximal (plateau): unicondylar, with
internal fixation
Open treatment of tibial fracture, proximal (plateau), bicondylar, with or
Closed treatment of intercondylar spine(s) and/or tuberosity fracture(s) of
knee, with manipulation
Open treatment of intercondylar spine(s) and or tuberosity(ies) fracture(s)
of knee, with or without internal or external fixation
27550 Closed treatnent of knee dislocation 35 ‫يساهم الصندوق‬
Open treatment of knee dislocation, with or without internal or external
27556 fixation: without primary ligamentous repair or 60 ‫يساهم الصندوق‬
augmentation/reconstruction
Open treatment of knee dislocation with or without internal or external
27558 fixation: with primary ligamentous repair, with or without 100 ‫يساهم الصندوق‬
augmentation/reconstruction
27560 Closed treatment of patellar dislocation 35 ‫يساهم الصندوق‬
Open treatment of patellar dislocation, with or without partial or total
patellectomy
Manipulation of knee joint under general anesthesia (includes application
of traction or other fixation devices)
27580 Fusion of knee, any technique 100 ‫يساهم الصندوق‬
Amputation, thigh, through femur, any level: with or without immediate
fitting technique including first cast
27594 Amputation, thigh, secondary closure or scar revision 55 ‫يساهم الصندوق‬
27598 Disarticulation at knee 60 ‫يساهم الصندوق‬
Decompression fasciotomy, leg: anterior and/or lateral compartment(s)
only
27601 Decompression fasciotomy, leg: posterior compartment(s) only 35 ‫يساهم الصندوق‬
Decompression fasciotomy, leg: anterior and/or lateral and posterior
compartment(s)
Incision and drainage, leg or ankle: deep abscess, hematoma, infected
bursa
27605 Tenotomy, Achilles tendon, subcutaneous (separate procedure) 25 ‫يساهم الصندوق‬
abscess), leg or ankle
Arthrotomy, ankle, for infection, with exploration, drainage or removal of
foreign body
Arthrotomy, ankle, posterior capsular release, with or without Achilles
tendon lengthening
27613 Biopsy, soft tissue of leg or ankle area 25 ‫يساهم الصندوق‬
Radical resection of tumor (eg, malignant neoplasm), soft tissue of leg or
ankle area
27618 Excision, tumor, leg or ankle area: subcutaneous 25 ‫يساهم الصندوق‬
27619 Excision, tumor, leg or ankle area: deep, subfascial or intramuscular 55 ‫يساهم الصندوق‬
Arthrotomy, ankle, with joint exploration, with or without biopsy, with or
without removal of loose or foreign body
27625 Arthrotomy, ankle, for synovectomy 40 ‫يساهم الصندوق‬
27626 Arthrotomy, ankle, for synovectomy: including tenosynovectomy 60 ‫يساهم الصندوق‬
Excision of lesion of tendon, sheath or capsule (eg, cyst or ganglion), leg
and/or ankle
27635 Excision or curettage of bone cyst or benign tumor, tibia or fibula 50 ‫يساهم الصندوق‬
Excision or curettage of bone cyst or benign tumor, tibia or fibula: with
autograft (includes obtaining graft) or allograft
(eg, for osteomyelitis or exostosis): tibia or fibula
27645 Resection for tumor, radical: tibia, fibula, talus or calcaneus 75 ‫يساهم الصندوق‬
27648 Injection procedure for ankle arthrography 10 ‫يساهم الصندوق‬
Repair, primary, open or percutaneous, ruptured Achilles tendon: with or
without graft
27654 Repair, secondary, ruptured Achilles tendon, with or without graft 65 ‫يساهم الصندوق‬
27656 Repair, fascial defect of leg 25 ‫يساهم الصندوق‬
Repair or suture of flexor or extensor tendon of leg: primary, without
graft, single, each
Repair or suture of flexor or extensor tendon of leg: secondary with graft,
single, each
27675 Repair for dislocating peroneal tendons: with or without fibular osteotomy 60 ‫يساهم الصندوق‬
Tenolysis, including tibia, fibula and ankle flexor: single multiple
(through same incision)
Lengthening or shortening of tendon, leg or ankle: single or multiple
(through same incision)
27687 Gastrocnemius recession (eg, Strayer procedure) 40 ‫يساهم الصندوق‬
Transfer or transplant of single tendon (with muscle redirection or
27691 rerouting): superficial anterior tibial or posterior tibial through 60 ‫يساهم الصندوق‬
interosseous space
Transfer or transplant of single tendon (with muscle redirection or
27692 rerouting): anterior tibial or posterior tibial through interosseous space, 25 ‫يساهم الصندوق‬
each additional tendon
Suture, primary, torn, ruptured or severed ligament, ankle: both collateral
ligaments
Suture, secondary repair, torn, ruptured or severed ligament, ankle,
collateral (e.g. Watson-Jones procedure)
27700 Arthroplasty, ankle 75 ‫يساهم الصندوق‬
27703 Arthroplasty, ankle: with implant or secondary reconstruction, total ankle 100 ‫يساهم الصندوق‬
27704 Removal of ankle implant (prosthesis) 40 ‫يساهم الصندوق‬
27705 Osteotomy: tibia or tibia and fibula 80 ‫يساهم الصندوق‬
27707 Osteotomy: fibula 40 ‫يساهم الصندوق‬
Osteotomy: multiple, with realignment on intramedullary rod (Sofield
type procedure), tibia and fibula
27715 Osteoplasty, tibia and fibula, lengthening 95 ‫يساهم الصندوق‬
Repair of nonunion or malunion, tibia: without graft (eg, compression
technique) or with sliding graft, local bone
Repair of nonunion or malunion, tibia: with iliac or other autograft
(includes obtaining graft) or by synostosis, with fibula, any method
27727 Repair of congenital pseudarthrosis, tibia 85 ‫يساهم الصندوق‬
Epiphyseal arrest by epiphysiodesis or stapling: distal tibia or distal tibia
and fibula
27732 Epiphyseal arrest by epiphysiodesis or stapling: distal fibula 40 ‫يساهم الصندوق‬
Epiphyseal arerst by epiphysiodesis or stapling, combined, proximal and
distal tibia and fibula
Epiphyseal arrest by epiphysiodesis or stapling, combined, proximal and
distal tibia, fibula: and distal femur
Closed treatment of tibial shaft fracture (with or without fibular fracture):
with manipulation
Percutaneous skeletal fixation of tibial shaft fracture (with or without
fibular fracture) (eg, pins or screws)
Open treatment of tibial shaft fracture (with or without fibular fracture),
with plate/screws, with or without cerclage
Open treatment of tibial shaft fracture, (with or without fibular fracture)
27759 by intramedullary implant, with or without interlocking screws and/or 90 ‫يساهم الصندوق‬
cerclage
Closed treatment of distal tibial fracture (medial malleolus): with
manipulation, with or without skeletal traction
Open treatment of medial malleolus fracture, with internal or external
fixation
Closed treatment of proximal or distal fibula or shaft fracture: with
manipulation
Open treatment of proximal or distal fibula or shaft fracture, with or
Treatment of closed bimalleolar or trimalleolar ankle fracture, (including
Pott's): with manipulation
Open treatment of bimalleolar or trimalleolar ankle fracture, with internal
27822 or external fixation, medial and/or lateral malleolus: without fixation of 65 ‫يساهم الصندوق‬
posterior lip
Open treatment of trimalleolar ankle fracture, with internal or external
fixation, medial and/or lateral malleolus: with fixation of posterior lip
Closed treatment of fracture of weight bearing articular portion of distal
27825 tibia (eg, pilon or tibial plafond), with or without anesthesia: with skeletal 40 ‫يساهم الصندوق‬
traction and/or requiring manipulation
Open treatment of fracture of weight bearing articular surface/portion of
27826 distal tibia (eg, pilon or tibial plafond), with internal or external fixation: 65 ‫يساهم الصندوق‬
of fibula or tibia only
Open treatment of fracture of weight bearing articular surface/portion of
27828 distal tibia (eg, pilon or tibial plafond), with or without internal or 105 ‫يساهم الصندوق‬
external fixation: of both tibia and fibula
27830 Closed treatment of proximal tibiofibular joint dislocation 25 ‫يساهم الصندوق‬
Open treatment of proximal tibiofibular joint dislocation with internal or
external fixation or excision of distal or proximal fibula
27840 Closed treatment of ankle dislocation 25 ‫يساهم الصندوق‬
27842 Closed treatment of ankle dislocation, with percutaneous skeletal fixation 40 ‫يساهم الصندوق‬
Open treatment of ankle dislocation, with or without percutaneous
skeletal fixation: without repair or internal fixation
Open treatment of ankle dislocation, with or without percutaneous
skeletal fixation: with repair or internal or external fixation
Manipulation of ankle under general anesthesia (includes application of
traction or other fixation apparatus)
27870 Arthrodesis, ankle, any method (separate procedure) 90 ‫يساهم الصندوق‬
27871 Arthrodesis, tibiofibular joint, proximal or distal (separate procedure) 60 ‫يساهم الصندوق‬
Amputation leg, through tibia and fibula: with or without immediate
fitting technique including application of first cast
27884 Amputation leg: secondary closure or scar revision 40 ‫يساهم الصندوق‬
Amputation ankle, through malleoli of tbia and fibula (Syme, Pirogoff
type procedures), with plastic closure and resection of nerves
27889 Ankle disarticulation 60 ‫يساهم الصندوق‬
Decompression fasciotomy, leg: posterior or anterior and/or lateral
compartments only, with debridement of nonviable muscle and/or nerve
28001 Incision and drainage, infected bursa, foot 25 ‫يساهم الصندوق‬
Deep dissection below fascia, for deep infection of foot, with or without
tendon sheath involvement: single bursal space, specify
Deep dissection below fascia, for deep infection of foot, with or without
tendon sheath involvement: multiple areas
abscess), foot
28008 Fasciotomy, foot and/or toe 25 ‫يساهم الصندوق‬
28010 Tenotomy, subcutaneous, toe: single or multiple 25 ‫يساهم الصندوق‬
Arthrotomy, with exploration, drainage or removal of loose or foreign
28020 body: intertarsal or tarsometatarsal joint or metatarsophalangeal joint or 35 ‫يساهم الصندوق‬
interphalangeal joint
28030 Neurectomy of intrinsic musculature of foot 35 ‫يساهم الصندوق‬
28035 Tarsal tunnel release (posterior tibial nerve decompression) 35 ‫يساهم الصندوق‬
28046 Radical resection of tumor (eg, malignant neoplasm), soft tissue of foot 50 ‫يساهم الصندوق‬
Arthrotomy for synovial biopsy: interphalangeal joint or
metatarsophalangeal or intertarsal or tarsometatarsal
28060 Fasciectomy, excision of plantar fascia:(separate procedure) 35 ‫يساهم الصندوق‬
Synovectomy, intertarsal, tarsometatarsal or metatarsophalangeal joint,
each
28072 Synovectomy, metatarsophalangeal joint, each 35 ‫يساهم الصندوق‬
28080 Excision of interdigital (Morton) neuroma, single, each 30 ‫يساهم الصندوق‬
28086 Synovectomy, tendon sheath, foot: flexor or extensor 25 ‫يساهم الصندوق‬
Excision of lesion of tendon or fibrous sheath or capsule (including
synovectomy) (cyst or ganglion): foot or toe
Excision or curettage of bone cyst or benign tumor, talus or calcaneus or
28102 metatarsal or phalanges of foot: with or without iliac or other autograft 45 ‫يساهم الصندوق‬
(includes obtaining graft) or allograft
Ostectomy, partial or complete excision: one or more metatarsal head or
tarsal coalition or calcaneus (bunionette) (separate procedure)
28120 (eg, for osteomyelitis or talar bossing), talus, calcaneus, tarsal, metatarsal 35 ‫يساهم الصندوق‬
bone, or phalanges of toe
28126 Condylectomy, phalangeal base, single toe, each 25 ‫يساهم الصندوق‬
28130 Talectomy (astragalectomy) 50 ‫يساهم الصندوق‬
28140 Metatarsectomy 50 ‫يساهم الصندوق‬
28150 Phalangectomy of toe, single, each head of phalanx, toe 25 ‫يساهم الصندوق‬
28160 Hemiphalangectomy or interphalangeal joint excision, toe, single, each 25 ‫يساهم الصندوق‬
28171 Radical resection for tumor: tarsal or metatarsal or phalanx of toe 50 ‫يساهم الصندوق‬
28192 Removal of foreign body, foot: deep 35 ‫يساهم الصندوق‬
Repair or suture of tendon, foot, flexor, single: primary or secondary,
Repair or suture of tendon, foot, flexor or extensor, single: primary or
secondary with free graft, single tendon (includes obtaining graft)
Tenolysis, flexor or extensor, foot: single or multiple (through same
incision)
Tenotomy, open, flexor or extensor: toe or foot, single or multiple
Advancement of posterior tibial tendon with excision of accessory
navicular bone (Kidner type procedure)
28240 Tenotomy, lengthening, or release, abductor hallucis muscle 35 ‫يساهم الصندوق‬
Division of plantar fascia and muscle (Steindler stripping) (separate
procedure)
Capsulotomy, midfoot: medial release only with or without tendon
lengthening (separate procedure)
Capsulotomy, midfoot: extensive, including posterior talotibial
capsulotomy and tendon(s) lengthening as for resistant clubfoot deformity
28264 Capsulotomy, midtarsal (Heyman type procedure) 70 ‫يساهم الصندوق‬
Capsulotomy for contracture: interphalangeal joint or
28270 metatarsophalangeal joint, with or without tenorrhaphy, single, each joint 25 ‫يساهم الصندوق‬
Webbing operation (create syndactylism of toes) for soft corn (Kelikian
type procedure)
28285 Hammertoe operation: one toe or for cock-up fifthh toe, any method 25 ‫يساهم الصندوق‬
Ostectomy, partial, exostectomy or condylectomy, single, metatarsal
head, first through fifth, each metatarsal head
Hallux valgus (bunion) correction: with or without metatarsal osteotomy
or tendon transfer
Osteotomy, phalanx, calcaneus or talus, midtarsal bones, metatarsal(s)
single or multiple
Reconstruction, angular deformity of toe (overlapping second toe, fifth
toe, curly toes),soft tissue procedures
28315 Sesamoidectomy, first toe (separate procedure) 25 ‫يساهم الصندوق‬
Repair of nonunion or malunion: tarsal bones or metatarsal, with or
without bone graft (includes obtaining graft)
Reconstruction, toe, macrodactyly: soft tissue resection or requiring bone
resection
Reconstruction, toe(s): polydactyly or syndactyly, with or without skin
graft(s), each web
Closed treatment or percutaneous skeletal fixation of calcaneal fracture:
with manipulation
Open treatment of closed or open calcaneal fracture, with or without
28420 internal or external skeletal fixation: with primary autogenous bone graft 85 ‫يساهم الصندوق‬
Closed treatment or percutaneous skeletal fixation of talus fracture: with
manipulation
Open treatment of talus fracture, with or without internal or external
fixation
Closed treatment or percutaneous skeletal fixation of tarsal bone fracture
(except talus and calcaneus): with manipulation, each
Open treatment of closed or open tarsal bone fracture (except talus and
calcaneus), with or without internal or external fixation, each
Closed treatment or percutaneous skeletal fixation of metatarsal fracture:
with manipulation
Open treatment of metatarsal fracture, with/without internal or external
fixation
Closed or open treatment or percutaneous skeletal fixation of fracture of
28496 any toe, phalanx or phalanges: with manipulation with or without fixation 25 ‫يساهم الصندوق‬
(internal or external), each
Closed or open treatment of sesamoid fracture, with or without internal
fixation
28540 Closed treatment of tarsal bone dislocation 25 ‫يساهم الصندوق‬
Percutaneous skeletal fixation of tarsal bone dislocation other than
talotarsal, with manipulation
Open treatment of tarsal bone dislocation, with or without internal or
external fixation
Closed treatment or percutaneous skeletal fixation of talotarsal joint
dislocation, with manipulation
Open treatment of talotarsal joint dislocation, with or without internal or
external fixation
28600 Closed treatment of tarsometatarsal joint dislocation 25 ‫يساهم الصندوق‬
Percutaneous skeletal fixation of tarsometatarsal joint dislocation, with
manipulation
Open treatment of tarsometatarsal joint dislocation with or without
Closed treatment or percutaneous skeletal fixation of metatarsophalangeal
joint dislocation, with manipulation
Open treatment of metatarsophalangeal joint dislocation, with or without
Closed treatment or percutaneous skeletal fixation of interphalangeal
28666 joint dislocation, with manipulation or open treatment with or without 25 ‫يساهم الصندوق‬
28705 Pantalar, triple or subtalar arthrodesis (separate procedure) 95 ‫يساهم الصندوق‬
Arthrodesis, midtarsal or tarsometatarsal, multiple or transverse: with or
without osteotomy as for flat foot correction (separate procedure)
Arthrodesis, midtarsal navicular-cuneiform, with tendon lengthening and
advancement (Miller type procedure) (separate procedure)
Arthrodesis, great toe: tarsometatarsal, metatarsophalangeal or
interphalangeal joint (separate procedure)
Arthrodesis, great toe, interphalangeal joint, with extensor hallucis longus
28760 transfer to first metatarsal neck (Jones type procedure) (separate 50 ‫يساهم الصندوق‬
procedure)
28800 Amputation, foot: midtarsal or transmetatarsal 50 ‫يساهم الصندوق‬
28810 Amputation, metatarsal, with toe, single 40 ‫يساهم الصندوق‬
28820 Amputation, toe: metatarsophalangeal joint 25 ‫يساهم الصندوق‬
29000 Application of halo type body cast 20 ‫يساهم الصندوق‬
29015 Application of Risser jacket, localizer, body and/or head 20 ‫يساهم الصندوق‬
29025 Application of turnbuckle jacket, body and/or head 20 ‫يساهم الصندوق‬
29035 Application of body cast, shoulder to hips 15 ‫يساهم الصندوق‬
Application of body cast, shoulder to hips: including head and/or one or
both thighs
29049 Application: plaster figure of eight 10 ‫يساهم الصندوق‬
29055 Application: shoulder spica 15 ‫يساهم الصندوق‬
29058 Application: plaster Velpeau 10 ‫يساهم الصندوق‬
29065 Application: shoulder to hand (long arm) cast 10 ‫يساهم الصندوق‬
29075 Application: elbow to finger (short arm) cast 10 ‫يساهم الصندوق‬
29085 Application: hand and lower forearm (gauntlet) cast 10 ‫يساهم الصندوق‬
29105 Application of short or long arm splint (static or dynamic) 5 ‫يساهم الصندوق‬
29130 Application of finger splint: static or dynamic 5 ‫يساهم الصندوق‬
29200 Strapping: thorax low back, shoulder, elbow or wrist, hand or finger 5 ‫يساهم الصندوق‬
29305 Application of hip spica cast: one leg 15 ‫يساهم الصندوق‬
29325 Application of hip spica cast: one and one half spica or both legs 20 ‫يساهم الصندوق‬
29355 Application of long leg cast (thigh to toes): walking or ambulatory type 10 ‫يساهم الصندوق‬
29365 Application of cylinder cast (thigh to ankle) 10 ‫يساهم الصندوق‬
Application of short leg cast (below knee to toes): walking or ambulatory
type
29435 Application of patellar bearing (PTB) cast 10 ‫يساهم الصندوق‬
29440 Adding walker to previously applied cast 5 ‫يساهم الصندوق‬
Application of clubfoot cast with moulding or manipulation, long or short
leg
29505 Application of short or long leg splint 5 ‫يساهم الصندوق‬
29520 Strapping: hip, knee, ankle or toes 5 ‫يساهم الصندوق‬
29580 Unna boot 5 ‫يساهم الصندوق‬
29590 Denis-Browne splint strapping 5 ‫يساهم الصندوق‬
29700 Removal or bivalving: gauntlet, boot, or body cast 5 ‫يساهم الصندوق‬
29705 Removal or bivalving: full arm or full leg cast, shoulder or hip spica 10 ‫يساهم الصندوق‬
29715 Removal or bivalving: turnbuckle jacket 5 ‫يساهم الصندوق‬
29720 Repair of spica, body cast or jacket 5 ‫يساهم الصندوق‬
29730 Windowing of cast 5 ‫يساهم الصندوق‬
29740 Wedging of cast 10 ‫يساهم الصندوق‬
Arthroscopy, diagnostic: any joint, with or without biopsy, limited
debridement, partial synovectoomy, removal of loose or foreign body,
lysis and resection of adhesios or lavage and drainage (separate
procedure)
29804 Arthroscopy, temporomandibular joint, surgical 45 ‫يساهم الصندوق‬
Arthroscopy, shoulder, surgical: with complete synovectomy, extensive
29819 debridement, decompression of subacromial space with partial 65 ‫يساهم الصندوق‬
acromioplasty with or without coracoacromial release
Arthroscopy, elbow, surgical: with complete synovectomy, or extensive
debridement
Arthroscopy, wrist, surgical: with complete synovectomy, extensive
29845 debridement, excision and/or repair of triangular fibrocartilage with or 50 ‫يساهم الصندوق‬
without debridement, or internal fixation for fracture instability
29848 Arthroscopy: wrist, surgical, with release of transverse carpal ligament 40 ‫يساهم الصندوق‬
Arthroscopically aided treatment of intercondylar spine(s) and/or
29850 tuberosity fracture(s) of the knee, with or without manipulation: with or 90 ‫يساهم الصندوق‬
without internal or external fixation (includes arthroscopy)
Arthroscopically aided treatment of tibial fracture, proximal (plateau):
29855 unicondylar, with or without internal or external fixation (includes 90 ‫يساهم الصندوق‬
arthroscopy)
Arthroscopically aided treatment of tibial fracture, proximal (plateau):
29856 bicondylar, with or without internal or external fixation (includes 95 ‫يساهم الصندوق‬
arthroscopy)
Arthroscopy, knee, surgical: for major synovectomy (2 or more
compartments), abrasion arthroplasty (includes chondroplasty where
necessary), medial OR lateral meniscectomy, lysis of adhesions, or
drilling for intact osteochondritis dissecans
Arthroscopy, knee, surgical: with meniscectomy (medial AND lateral,
including any meniscal shaving), or meniscus repair (medial OR lateral)
29883 Arthroscopy, knee, surgical: with meniscus repair (medial AND lateral) 90 ‫يساهم الصندوق‬
Arthroscopy, knee, surgical: with drilling for osteochondritis dissecans
29885 with bone graft, with or without internal fixation (with debridement of 70 ‫يساهم الصندوق‬
base of lesion)
Arthroscopically aided anterior OR posterior cruciate ligament
repair/augmentation or reconstruction
Arthroscopy, ankle (tibiotalar and fibulotalar joints) surgical: with
removal of loose body or foreign body, or synovectomy
30000 Drainage abscess or hematoma, nasal (separate procedure) 10 ‫يساهم الصندوق‬
30100 Biopsy, intranasal (separate procedure) 10 ‫يساهم الصندوق‬
30110 Excision, nasal polyp(s) 15 ‫يساهم الصندوق‬
30120 Excision or surgical planing, skin of nose, for rhinophyma 45 ‫يساهم الصندوق‬
30124 Excision dermoid cyst, nose: simple, skin, subcutaneous 15 ‫يساهم الصندوق‬
30125 Excision dermoid cyst, nose: complex, under bone or cartilage 50 ‫يساهم الصندوق‬
30140 Submucous resection turbinate, complete or partial 30 ‫يتطلب موافقة‬
30160 Rhinectomy 60 ‫يساهم الصندوق‬
30200 Injection into turbinate(s), therapeutic (separate procedure) 5 ‫يساهم الصندوق‬
30220 Insertion, nasal septal prosthesis (button) 10 ‫ال يساهم الصندوق‬
30300 Removal foreign body, intranasal: requiring general anesthesia 15 ‫يساهم الصندوق‬
30320 Removal foreign body, intranasal: by lateral rhinotomy 50 ‫يساهم الصندوق‬
30400 Rhinoplasty, primary or secondary, with or without turbinectomy 80 ‫ال يساهم الصندوق‬
30430 Rhinoplasty, secondary: minor revision (tip rhinoplasty) 45 ‫ال يساهم الصندوق‬
30520 Submucous resection of nasal septum 40 ‫يتطلب موافقة‬
30540 Repair choanal atresia: intranasal 60 ‫يساهم الصندوق‬
30545 Repair choanal atresia: transpalatine 80 ‫يساهم الصندوق‬
30560 Lysis intranasal synechia 10 ‫يساهم الصندوق‬
30620 Septal or other intranasal dermatoplasty (no graft included) 50 ‫ال يساهم الصندوق‬
30630 Repair nasal septal perforations or fistula 50 ‫يساهم الصندوق‬
30801 Cauterization and/or ablation, mucosa of turbinates (separate procedure) 15 ‫يساهم الصندوق‬
30901 Control nasal hemorrhage, any method (separate procedure) 15 ‫يساهم الصندوق‬
30920 Ligation arteries: ethmoidal or internal maxillary artery, transantral 55 ‫يساهم الصندوق‬
Lavage by cannulation: sphenoid or maxillary sinus (antrum puncture, or
natural ostium)
31020 Sinusotomy, maxillary (antrotomy): intranasal 20 ‫يساهم الصندوق‬
Sinusotomy maxillary (antrotomy): radical (Caldwell-Luc), with or
without removal of antrochoanal polyps
31040 Pterygomaxillary fossa surgery, any approach 60 ‫يساهم الصندوق‬
31070 Sinusotomy, sphenoid, frontal or intanasal 40 ‫يساهم الصندوق‬
Sinusotomy frontal: transorbital, unilateral (for mucocele or osteoma,
Lynch type)
31080 Sinusotomy frontal: obliterative or nonbiliterarive 85 ‫يساهم الصندوق‬
31090 Sinusotomy combined, three or more sinuses 75 ‫يساهم الصندوق‬
31200 Ethmoidectomy 50 ‫يساهم الصندوق‬
31215 Maxillectomy: with or without orbital exenteration 120 ‫يساهم الصندوق‬
31231 Nasal endoscopy, diagnostic: unilateral or bilateral (separate procedure) 5 ‫يساهم الصندوق‬
Nasal/sinus endoscopy, diagnostic: with maxillary or sphenoid
sinusoscopy
Nasal/sinus endoscopy, surgical: with biopsy, polypectomy, debridement,
control of epistaxis or concha bullosa resection (separate procedure)
31239 Nasal/sinus endoscopy, surgical: with dacryocystorhinostomy 50 ‫يساهم الصندوق‬
31254 Nasal/sinus endoscopy, surgical: with total or partial ethmoidectomy 35 ‫يساهم الصندوق‬
Nasal/sinus endoscopy, surgical: with maxillary antrostomy, with or
without removal of tissue from maxillary sinus
Nasal/sinus endoscopy, surgical: with frontal sinus exploration, with or
without removal of tissue from frontal sinus
Nasal/sinus endoscopy, surgical: with sphenoidotomy, with or without
removal of tissue from sphenoid sinus
Nasal/sinus endoscopy, surgical, with repair of cerebrospinal fluid leak:
ethmoid or sphenoid region
31292 Nasal/sinus endoscopy, surgical: with orbital wall decompression 95 ‫يساهم الصندوق‬
31294 Nasal/sinus endoscopy, surgical: with optic nerve decompression 115 ‫يساهم الصندوق‬
Laryngotomy (thyrotomy, laryngofissure): with removal of tumor or
laryngocele, cordectomy
Laryngectomy: total or subtotal supraglottic, without radical neck
dissection
31365 Laryngectomy: total, with radical neck dissection 160 ‫يساهم الصندوق‬
31368 Laryngectomy: subtotal supraglottic, with radical neck dissection 150 ‫يساهم الصندوق‬
31370 Partial laryngectomy (hemilaryngectomy) 100 ‫يساهم الصندوق‬
Pharyngolaryngectomy with radical neck dissection: without
reconstruction
31395 Pharyngolaryngectomy with radical neck dissection: with reconstruction 190 ‫يساهم الصندوق‬
31400 Arytenoidectomy or arytenoidopexy, external approach 60 ‫يساهم الصندوق‬
31420 Epiglottidectomy 60 ‫يساهم الصندوق‬
31500 Endotracheal intubation and ventilation (emergency procedure) 15 ‫يساهم الصندوق‬
Laryngoscopy, direct or indirect, diagnostic with or without biopsy
Laryngoscopy, direct, diagnostic with or without biopsy (separate
procedure) newborn
Laryngoscopy, direct, with or without tracheoscopy: diagnostic, with
31526 operating microscope with or without biopsy or removal of foreign body 30 ‫يساهم الصندوق‬
Laryngoscopy, direct, operative, with excision of vocal cord nodule(s) or
31540 polyp(s) and or stripping of vocal cords, with or without operating 45 ‫يساهم الصندوق‬
microscope
31578 Laryngoscopy, flexible fiberoptic: therapeutic (separate procedure) 20 ‫يساهم الصندوق‬
31580 Laryngoplasty other than cricoid split 100 ‫يساهم الصندوق‬
Treatment of closed laryngeal fracture: with closed manipulative
reduction
31587 Laryngoplasty, cricoid split 55 ‫يساهم الصندوق‬
31590 Laryngeal reinnervation by neuromuscular pedicle 100 ‫يساهم الصندوق‬
Section recurrent laryngeal nerve, therapeutic, unilateral (separate
procedure)
31600 Tracheostomy, (separate procedure) 30 ‫يساهم الصندوق‬
Construction of tracheoesophageal fistula and subsequent insertion of an
alaryngeal speech prosthesis (eg, voice button, Blom-Singer prosthesis)
Tracheal puncture, percutaneous for aspiration of mucus (transtracheal
aspiration) (separate procedure)
31613 Tracheostoma revision (separate procedure) 35 ‫يساهم الصندوق‬
31615 Tracheobronchoscopy through established tracheostomy incision 15 ‫يساهم الصندوق‬
Bronchoscopy, flexible or rigid: diagnostic (with or without cell washing
31625 or brushing, biopsy, transbronchial lung biopsy, or therapeutic aspiration 35 ‫يساهم الصندوق‬
of tracheobronchial tree) (separate procedure)
Bronchoscopy, flexible or rigid: therapeutic (removal of foreign body,
bronchial dilation and placement of stent, closed reduction of fracture,
excision of tumor, or destruction of tumor or relief of stenosis by any
method other than excision (eg, l
Brochoscopy: with injection of contrast material for segmental
bronchography (fiberscope only)
31708 Instillation of contrast material for laryngography, without catheterization 10 ‫يساهم الصندوق‬
Catheterization for bronchography, with or without the injection of
contrast material
31715 Transtracheal injection for bronchography 10 ‫يساهم الصندوق‬
31750 Tracheoplasty: cervical 60 ‫يساهم الصندوق‬
31760 Tracheoplasty: intrathoracic 140 ‫يساهم الصندوق‬
31766 Carinal reconstruction 140 ‫يساهم الصندوق‬
31770 Bronchoplasty 140 ‫يساهم الصندوق‬
31780 Excision tracheal stenosis, tumor or carcinoma and anastomosis: cervical 100 ‫يساهم الصندوق‬
31786 Excision of tracheal tumor or carcinoma: thoracic 140 ‫يساهم الصندوق‬
31800 Tracheorrhaphy, suture of external tracheal wound or injury 50 ‫يساهم الصندوق‬
Closure of tracheostomy or tracheal fistula: with or without plastic repair
31830 Revision of tracheostomy scar (separate procedure) 30 ‫يساهم الصندوق‬
Thoracentesis, puncture of pleural cavity for aspiration, initial or
subsequent
32005 Chemical pleurodesis (eg, for recurrent or persistent pneumothorax) 15 ‫يساهم الصندوق‬
32020 Tube thoracostomy with or without water seal (separate procedure) 25 ‫يساهم الصندوق‬
32035 Thoracostomy: with rib resection for empyema 50 ‫يساهم الصندوق‬
Thoracotomy: with exploration and biopsy, control of hemorrhage or
postoperative complications
Thoracotomy, major: with cyst(s) removal, with or without
pneumonolysis, or removal of intrapleural foreign body or clots
Thoracotomy, major: with excision-plication of bullae, with or without
any pleural procedure
32220 Decortication, pulmonary, (separate procedure): total 100 ‫يساهم الصندوق‬
32310 Pleurectomy, parietal (separate procedure) 85 ‫يساهم الصندوق‬
32400 Biopsy, pleura: percutaneous needle, one or more specimens 15 ‫يساهم الصندوق‬
32402 Biopsy, pleura: open 50 ‫يساهم الصندوق‬
32405 Biopsy, lung or mediastinum, percutaneous needle 15 ‫يساهم الصندوق‬
32440 Pneumonectomy 150 ‫يساهم الصندوق‬
Lobectomy, total or segmental, with or without bronchoplasty or
decortication
32500 Wedge resection of lung, single or multiple 100 ‫يساهم الصندوق‬
32601 Thoracoscopy, diagnostic, with or without biopsy (separate procedure) 50 ‫يساهم الصندوق‬
32650 Thoracoscopy,surgical: with pleurodesis, any method 100 ‫يساهم الصندوق‬
Thoracoscopy, surgical: with pulmonary decortication, with or without
intrapleural pneumonolysis
Thoracoscopy, surgical: with removal of intrapleural foreign body, fibrin
or control of traumatic hemorrhage,
Thoracoscopy, surgical: with excision-plication of bullae, including any
pleural procedure, with or without parietal pleurectomy
Thoracoscopy, surgical: with removal of clot or foreign body from
pericardial sac, creation of pericardial window, partial resection of
pericardial sac for drainage, total pericardiectomy, or excision of
pericardial cyst, tumor or mass
32662 Thoracoscopy, surgical: with excision of mediastinal cyst, tumor, or mass 95 ‫يساهم الصندوق‬
Thoracoscopy, surgical: with segmental or total lobectomy, or wedge
resection(s) of lung
32664 Thoracoscopy, surgical: with thoracic sympathectomy 85 ‫يساهم الصندوق‬
32665 Thoracoscopy, surgical: with esophagomyotomy 100 ‫يساهم الصندوق‬
32800 Repair lung hernia through chest wall 60 ‫يساهم الصندوق‬
Closure of chest wall following open flap drainage for empyema (Clagett
type procedure)
32815 Open closure of major bronchial fistula 150 ‫يساهم الصندوق‬
32820 Major reconstruction, chest wall (post traumatic) 100 ‫يساهم الصندوق‬
32900 Resection of ribs, extrapleural, all stages 60 ‫يساهم الصندوق‬
32905 Thoracoplasty 150 ‫يساهم الصندوق‬
32940 Pneumonolysis, extrapleural, including filling or packing procedures 70 ‫يساهم الصندوق‬
32960 Pneumothorax, therapeutic 15 ‫يساهم الصندوق‬
Cardiopulmonary bypass (extracorporeal circulation): add to primary
procedure if performed
Total circulatory arrest under cardiopulmonary bypass: add to primary
procedure
33010 Pericardiocentesis 15 ‫يساهم الصندوق‬
33015 Tube pericardiostomy 30 ‫يساهم الصندوق‬
33020 Pericardiotomy, with removal of foreign body (primary procedure) 75 ‫يساهم الصندوق‬
33025 Creation of pericardial window or partial resection for drainage 75 ‫يساهم الصندوق‬
33030 Pericardiectomy, complete (separate procedure) 115 ‫يساهم الصندوق‬
33050 Excision of pericardial cyst or tumor 90 ‫يساهم الصندوق‬
33120 Excision of intracardiac tumor 130 ‫يساهم الصندوق‬
Insertion of permanent pacemaker with epicardial electrode(s): open
procedure
Insertion of or replacement of permanent pacemaker with transvenous
electrode(s): atrial or ventricular
Insertion or replacement of permanent pacemaker with transvenous
electrode(s): atrial and ventricular
Insertion or replacement of temporary transvenous single chamber
cardiac electrode, or pacemaker catheter (separate procedure)
Insertion or replacement of temporary transvenous dual chamber pacing
electrodes (separate procedure)
Insertion or replacement of pacemaker pulse generator only: single
chamber
33213 Insertion or replacement of pacemaker pulse generator only: dual chamber 40 ‫يساهم الصندوق‬
Insertion or eplacement of implantable cardioverter-defibrillator pulse
generator only
Implantation of automatic implantable cardioverter-defibrillator pads with
or without sensing electrodes
Insertion or replacement of implantable cardioverter-defibrillator lead(s)
by other than thoracotomy
Insertion or replacement of implantable cardioverter-defibrillator lead(s)
33249 by other than thoracotomy: with insertion of cardio-defibrillator pulse 85 ‫يساهم الصندوق‬
generator
Operative ablation of supraventricular arrhythmogenic focus or pathway
33250 (eg, Wolff-Parkinson-White, A-V node re-entry), tract(s), and or focus 150 ‫يساهم الصندوق‬
(foci)
33300 Repair of cardiac wound or removal of foreign body 100 ‫يساهم الصندوق‬
33320 Suture repair of aorta or great vessels 100 ‫يساهم الصندوق‬
33330 Insertion of graft, aorta or great vessels 135 ‫يساهم الصندوق‬
33400 Valvuloplasty, aortic valve, open 130 ‫يساهم الصندوق‬
33404 Construction of apical-aortic conduit 180 ‫يساهم الصندوق‬
Replacement, aortic valve: with or without aortic annulus enlargement,
noncoronary cusp
33416 Resection or incision of subvalvular aortic stenosis 175 ‫يساهم الصندوق‬
33417 Aortoplasty (gusset) for supravalvular stenosis 175 ‫يساهم الصندوق‬
33420 Valvotomy, mitral valve (commisurotomy): closed 145 ‫يساهم الصندوق‬
33425 Valvuloplasty, mitral valve, any method 150 ‫يساهم الصندوق‬
33430 Replacement, mitral valve 125 ‫يساهم الصندوق‬
33452 Valvotomy, tricuspid valve 95 ‫يساهم الصندوق‬
Valvuloplasty or valvectomy, tricuspid valve, with or without insertion
of tricuspid ring
Tricuspid valve replacement or repositioning and plication for Ebstein
anomaly
33472 Valvotomy, pulmonary valve (commisurotomy) closed or open 95 ‫يساهم الصندوق‬
Right ventricular resection for infundibular stenosis, with or without
commisurotomy or gusset
33478 Pulmonary artery patch for supraventricular stenosis 140 ‫يساهم الصندوق‬
33480 Double valve procedure 250 ‫يساهم الصندوق‬
33483 Triple valve pocedure 270 ‫يساهم الصندوق‬
33500 Repair of coronary arteriovenous or arteriocardiac chamber fistula 110 ‫يساهم الصندوق‬
33503 Anomalous coronary artery: graft 130 ‫يساهم الصندوق‬
33505 Anomalous coronary artery: reimplantation 200 ‫يساهم الصندوق‬
Coronary artery bypass, single coronary graft, vein or artery, (includes
obtaining graft)
Coronary artery bypass, double coronary graft, vein or artery, (includes
obtaining grafts), with or without endarterectomy
Coronary artery bypass, triple coronary graft, vein or artery, (includes
obtaining grafts), with or without endarterectomy
Coronary artery bypass, four or more coronary grafts, vein or artery,
(includes obtaining grafts), with or without endarterectomy
33542 Myocardial resection (eg, repair of myocardial aneurysm) 130 ‫يساهم الصندوق‬
Repair of postinfarction ventricular septal defect, with or without
myocardial resection
33641 Repair atrial septal defect, secundum, with or without patch 100 ‫يساهم الصندوق‬
Direct or patch closure, sinus venosus, with or without anomalous
pulmonary venous drainage
Repair of atrial septal defect and ventricular septal defect, with direct or
patch closure
33648 Correction of cor triatriatum 190 ‫يساهم الصندوق‬
33649 Repair of tricuspid atresia 270 ‫يساهم الصندوق‬
33650 Bicaval - bipulmonary bypass procedure 270 ‫يساهم الصندوق‬
Repair of incomplete or partial atrioventricular canal (ostium primum
atrial septal defect), with or without atrioventricular valve repair
33670 Repair of complete atrioventricular canal, with prosthetic valve 250 ‫يساهم الصندوق‬
33681 Closure of ventricular septal defect, with or without patch 180 ‫يساهم الصندوق‬
Closure of ventricular septal defect, with pulmonary valvotomy or
infundibular resection, with or without patch
33690 Banding of pulmonary artery 100 ‫يساهم الصندوق‬
Complete repair of tetralogy of Fallot: with or without closure of previous
shunt
Repair sinus of Valsalva fistula, with/ without repair of ventricular septal
defect
33720 Repair sinus of Valsalva aneurysm 90 ‫يساهم الصندوق‬
33730 Complete repair of total anomalous venous return 200 ‫يساهم الصندوق‬
33735 Atrial septectomy or septostomy any method 120 ‫يساهم الصندوق‬
33750 Shunt: systemic or vena cava to pulmonary artery, with or without graft 120 ‫يساهم الصندوق‬
33774 Repair of transposition of the great arteries, any method 300 ‫يساهم الصندوق‬
33784 Total repair of double outlet ventricle 350 ‫يساهم الصندوق‬
33785 Total repair of single ventricle (double inlet ventricle) 350 ‫يساهم الصندوق‬
33786 Total repair, truncus arteriosus (Rastelli type operation) 200 ‫يساهم الصندوق‬
33788 Reimplantation of anomalous pulmonary artery 125 ‫يساهم الصندوق‬
Aortic suspension (aortopexy) for tracheal decompression (eg, for
tracheomalacia) (separate procedure)
33803 Division of aberrant vessel (vascular ring): with or without reanastomosis 120 ‫يساهم الصندوق‬
33813 Obliteration of aortopulmonary septal defect 100 ‫يساهم الصندوق‬
33820 Patent ductus arteriosus: ligation and/or division, any age 120 ‫يساهم الصندوق‬
Excision or repair of coarctation of aorta, with or without associated
patent ductus arteriosus, any type
Ascending aorta graft, with or without valve suspension, with or without
coronary reconstruction, with or without aortic root replacement
33870 Transverse arch graft, with or without cardiopulmonary by-pass 210 ‫يساهم الصندوق‬
33875 Descending thoracic aorta graft, with or without cardiopulmonary by-pass 175 ‫يساهم الصندوق‬
33877 Repair of thoracoabdominal aortic aneurysm with graft 230 ‫يساهم الصندوق‬
33916 Pulmonary embolectomy or endarterectomy with or without embolectomy 125 ‫يساهم الصندوق‬
Donor cardiectomy with or without pneumonectomy, with preparation
and maintenance of allograft
33935 Heart-lung transplant with recipient cardiectomy-pneumonectomy 385 ‫يتطلب موافقة‬
33945 Heart transplant, with or without recipient cardiectomy 275 ‫يتطلب موافقة‬
33970 Intra-aortic balloon counterpulsation: add to primary procedure 30 ‫يساهم الصندوق‬
33975 Implantation and removal of ventricle assist device: single ventricle 130 ‫يساهم الصندوق‬
33976 Implantation and removal of ventricle assist device: double ventricle 175 ‫يساهم الصندوق‬
Arterial embolectomy or thrombectomy, with or without catheter: carotid,
34001 subclavian, innominate, axillary, brachial, radial, or ulnar artery (separate 85 ‫يساهم الصندوق‬
procedure)
Arterial embolectomy or thrombectomy, with or without catheter: renal,
celiac, mesenteric, aortoiliac artery (separate procedure)
Arterial embolectomy or thrombectomy, with or without catheter:
34203 popliteal-tibio-peroneal, femoropopliteal, or aortoiliac artery (separate 80 ‫يساهم الصندوق‬
procedure)
Venous thrombectomy, direct or with catheter: vena cava, iliac, or
femoropopliteal vein by abdominal or by leg incision (separate procedure)
Venous thrombectomy, direct or with catheter: vena cava, iliac, or

femoropopliteal vein, by abdominal and leg incision (separate procedure)
Venous thrombectomy, direct or with catheter: axillary and subclavian
vein, by neck or arm incision (separate procedure)
34501 Valvuloplasty, femoral vein (separate procedure) 120 ‫يساهم الصندوق‬
34510 Venous valve transposition, any vein donor (separate procedure) 120 ‫يساهم الصندوق‬
34520 Cross-over vein graft to venous system (separate procedure) 120 ‫يساهم الصندوق‬
34530 Saphenopopliteal vein anastomosis (separate procedure) 120 ‫يساهم الصندوق‬
Direct repair of aneurysm, false aneurysm, or excision and graft insertion,
with or without patch graft for aneurysm, ruptured aneurysm, or
occlusive disease: carotid, subclavian, innominate, vertebral, or
axillary- brachial artery
35045 with or without patch graft: for aneurysm, false aneurysm, ruptured 75 ‫يساهم الصندوق‬
aneurysm or occlusive disease, radial or ulnar artery
Direct repair of aneurysm,false aneurysm, or excision and graft insertion,
35082 with or without patch graft: for aneurysm, false aneurysm, or occlusive 200 ‫يساهم الصندوق‬
disease, abdominal aorta, visceral artery, iliac artery
35092 with or without patch graft: for ruptured aneurysm, abdominal aorta 225 ‫يساهم الصندوق‬
involving visceral vessels
Direct repair of aneurysm, false aneurysm,or excision and graft insertion,
with or without patch graft: for aneurysm, false aneurysm or occlusive
disease, iliac (common, hypogastric, external), common femoral, or
popliteal artery
35132 with or without patch graft: for ruptured aneurysm iliac (common, 125 ‫يساهم الصندوق‬
hypogastric, external), common femoral, or popliteal artery
35180 Repair, congenital arteriovenous fistula: head and neck or extremities 85 ‫يساهم الصندوق‬
35182 Repair, congenital arteriovenous fistula: thorax and abdomen 110 ‫يساهم الصندوق‬
Repair, acquired or traumatic arteriovenous fistula: head and neck thorax
and abdomen, or lower limbs
35201 Repair blood vessel, direct: neck, extremity, hand, finger, without graft 70 ‫يساهم الصندوق‬
35211 Repair blood vessel, direct: intrathoracic, with bypass, without graft 140 ‫يساهم الصندوق‬
35216 Repair blood vessel, direct: intrathoracic, without bypass 120 ‫يساهم الصندوق‬
35221 Repair blood vessel, direct or with graft: intra-abdominal 110 ‫يساهم الصندوق‬
35231 Repair blood vessel, with graft: neck, extremity, hand, finger 80 ‫يساهم الصندوق‬
35241 Repair blood vessel, with graft: intrathoracic, with bypass 150 ‫يساهم الصندوق‬
35246 Repair blood vessel, with graft: intrathoracic without bypass 125 ‫يساهم الصندوق‬
Thromboendarterectomy, with or without patch graft: carotid, vertebral,
subclavian, innominate
Thromboendarterectomy, with or without patch graft: abdominal aorta,
and/or major branches, iliac - femoral
Thromboendarterectomy, with or without patch graft: axillary, brachial,
35381 common femoral, deep (profunda), femoral and/or popliteal, and/or 100 ‫يساهم الصندوق‬
tibioperoneal
35470 Transluminal balloon angioplasty, percutaneous: any vessel 55 ‫يساهم الصندوق‬
35480 Transluminal peripheral atherectomy, open or percutaneous: any vessel 55 ‫يساهم الصندوق‬
Bypass graft, with vein or prosthesis: carotid, subclavian , vertebral,
axillary,
Bypass graft, with vein or prosthesis: aorto-splenic, renal, iliac, celiac, or
mesenteric
35583 In-situ or reversed vein bypass: femoral-popliteal, or femoral-tibial 150 ‫يساهم الصندوق‬
35681 Bypass graft, composite 60 ‫يساهم الصندوق‬
Exploration (not followed by surgical repair), with or without lysis of
artery: carotid, femoral, popliteal, or other artery
Exploration for postoperative hemorrhage, thrombosis, or infection: neck,
extremity (separate procedure)
Exploration for postoperative hemorrhage, thrombosis, or infection:
abdomen, chest (separate procedure)
35870 Repair of graft-enteric fistula 140 ‫يساهم الصندوق‬
35875 Thrombectomy and/or repair of arterial or venous graft 70 ‫يساهم الصندوق‬
35901 Excision of infected graft 70 ‫يساهم الصندوق‬
Introduction of catheter, superior or inferior vena cava (separate
procedure)
36011 Selective catheter placement, venous system: any site (separate procedure) 15 ‫يساهم الصندوق‬
36100 Introduction of needle or intracatheter: any site (separate procedure) 15 ‫يساهم الصندوق‬
36215 Selective catheter placement, arterial system: any site (separate procedure) 35 ‫يساهم الصندوق‬
Selective catheter placement, coronary artery, single or multiple (separate
procedure)
Insertion of implantable intra-arterial infusion pump (eg, for
chemotherapy of liver) (separate procedure)
36261 Revision of implanted intra-arterial infusion pump (separate procedure) 35 ‫يساهم الصندوق‬
36262 Removal of implanted intra-arterial infusion pump (separate procedure) 25 ‫يساهم الصندوق‬
Placement of peripheral venous catheter by cutdown (outside O.R.)
36450 Exchange transfusion, blood 20 ‫يساهم الصندوق‬
36460 Transfusion, intrauterine, fetal 35 ‫يساهم الصندوق‬
36470 Injection of sclerosing solution 10 ‫ال يساهم الصندوق‬
36481 Percutaneous portal vein catheterization by any method 45 ‫يساهم الصندوق‬
Placement of central venous catheter (subclavian, jugular, or other vein):
percutaneous or cutdown separate procedure)
Repositioning of previously placed central venous catheter under
fluoroscopic guidance (separate procedure)
36510 Catheterization of umbilical vein (separate procedure) 10 ‫يساهم الصندوق‬
Percutaneous insertion or revision of implantable intravenous infusion
pump chamber or Broviac catheter (separate procedure)
Insertion or revision of implantable intravenous pump, chamber, or
Broviac catheter, open procedure
36532 Removal of implantable intravenous infusion pump (separate procedure) 20 ‫يساهم الصندوق‬
Removal of implantable pediatric intravenous infusion pump or Broviac
catheter (separate procedure)
Arterial catheterization or cannulation for sampling, monitoring or
36620 transfusion (separate procedure): percutaneous or cutdown, or prolonged 10 ‫يساهم الصندوق‬
infusion therapy
36660 Catheterization, umbilical artery, newborn, for diagnosis or therapy 10 ‫يساهم الصندوق‬
36821 Arterio-venous anastomosis, direct, any site 60 ‫يساهم الصندوق‬
36825 Creation of arteriovenous fistula: any graft 70 ‫يساهم الصندوق‬
Revision of an arteriovenous fistula, with or without thrombectomy,
autogenous or non-autogenous graft
36834 Plastic repair of arteriovenous aneurysm 65 ‫يساهم الصندوق‬
36835 Transposition of basilic vein A-V fistula 80 ‫يساهم الصندوق‬
36861 Cannula declotting: with or without balloon catheter 15 ‫يساهم الصندوق‬
Anastomosis: portocaval, renoportal, caval-mesenteric or splenorenal,
proximal
Anastomosis: splenorenal, distal (selective decompression of
esophagogastric varices, any technique)
37190 Plastic repair of arteriovenous aneurysm 60 ‫يساهم الصندوق‬
Transcatheter retrieval, percutaneous, of intravascular foreign body (eg,
fractured venous or arterial catheter)
Transcatheter occlusion or embolization (eg, for tumor destruction, to
37204 achieve hemostasis, to occlude a vascular malformation), percutaneous, 120 ‫يساهم الصندوق‬
any method, non-central nervous system, non-head or neck
Transcatheter placement of an intravascular stent, (non coronary vessel),
percutaneous or open: initial vessel
Transcatheter placement of an intravascular stent, (non coronary vessel),
percutaneous or open: each additional vessel
37565 Ligation of internal jugular vein or carotid artery 35 ‫يساهم الصندوق‬
37609 Ligation or biopsy, temporal artery 15 ‫يساهم الصندوق‬
37615 Ligation, major artery (eg, post-traumatic, rupture): neck 30 ‫يساهم الصندوق‬
37616 Ligation, major artery (eg, post-traumatic, rupture): chest or abdomen 100 ‫يساهم الصندوق‬
37618 Ligation, major artery (eg, post-traumatic, rupture): extremity 30 ‫يساهم الصندوق‬
Interruption, partial or complete, of inferior vena cava by suture, ligation,
plication, clip, extravascular, intravascular (umbrella device)
Interruption, partial or complete, of femoral vein, by ligature,
intravascular device
Interruption, partial or complete, of common iliac vein by ligature,
intravascular device
Ligation and division of long saphenous vein at saphenofemoral junction,
or distal interruptions
Ligation and division and complete stripping of long and/or short
saphenous veins, open or endoscopic
Ligation,division and complete stripping, long or short saphenous veins,
37735 and radical with excision of ulcer,and skin graft, interruption of 70 ‫يساهم الصندوق‬
communicating veins, and excision of deep fascia, open or endoscopic
Ligation of perforators, subfascial, radical (Linton type), with or without
skin graft, open or endoscopic
Ligation and division of short saphenous vein at saphenopoplit-eal
junction (separate procedure)
Ligation, division, and/or excision of recurrent or secondary varicose
veins (clusters), one leg
38100 Splenectomy 90 ‫يساهم الصندوق‬
38115 Repair of ruptured spleen with or without partial splenectomy 90 ‫يساهم الصندوق‬
38200 Injection procedure for splenoportography 20 ‫يساهم الصندوق‬
38230 Bone marrow harvesting for transplantation, per site 30 ‫يتطلب موافقة‬
Blood-derived peripheral stem cell harvesting for transplantation, (per
collection)
38240 Bone marrow or blood-derived peripheral stem cell transplantation 15 ‫يتطلب موافقة‬
38300 Drainage of lymph node abscess or lymphadenitis 20 ‫يساهم الصندوق‬
38380 Suture and/or ligation of thoracic duct: cervical approach 45 ‫يساهم الصندوق‬
38381 Suture and/or ligation of thoracic duct: transthoracic approach 85 ‫يساهم الصندوق‬
38382 Suture and/or ligation of thoracic duct: abdominal approach 60 ‫يساهم الصندوق‬
38500 Biopsy or excision of lymph node(s): superficial (separate procedure) 20 ‫يساهم الصندوق‬
Biopsy of lymph node(s): by needle, superficial (eg, cervical, inguinal, or
axillary)
Biopsy or excision of lymph node(s): deep (cervical with or without
excision of scalene fat pad, or axillary nodes) (separate procedure)
Biopsy or excision of lymph node(s): internal mammary node(s)
Excision of cystic hygroma, axillary or cervical, without deep
neurovascular dissection
Excision of cystic hygroma, axillary or cervical, with deep neurovascular
dissection
Limited lymphadenectomy for staging (separate procedure): pelvic and
para-aortic, retroperitoneal (aortic and/or splenic)
38700 Radical lymphadenectomy: suprahyoid 60 ‫يساهم الصندوق‬
38720 Radical lymphadenectomy: cervical (complete) 90 ‫يساهم الصندوق‬
38724 Cervical lymphadenectomy (modified radical neck dissection) 90 ‫يساهم الصندوق‬
38745 Radical lymphadenectomy: axillary 80 ‫يساهم الصندوق‬
38760 Radical lymphadenectomy: inguinofemoral, superficial 50 ‫يساهم الصندوق‬
Radical lymphadenectomy: inguinofemoral, superficial, in continuity
38765 with pelvic lymphadenectomy, including external iliac, hypogastric, and 100 ‫يساهم الصندوق‬
obturator nodes (separate procedure)
Radical lymphadenectomy: pelvic, including external iliac, hypogastric,
and obturator nodes (separate procedure)
Radical lymphadenectomy: retroperitoneal, including pelvic, aortic, and
renal nodes
38790 Injection procedure for lymphangiography 10 ‫يساهم الصندوق‬
Mediastinotomy, with exploration, drainage, or removal of foreign body:
cervical approach
Mediastinotomy, with exploration, drainage, or removal of foreign body:
transthoracic approach or sternal split
39200 Excision of mediastinal cyst 80 ‫يساهم الصندوق‬
39220 Excision of mediastinal tumor 100 ‫يساهم الصندوق‬
39400 Mediastinoscopy, with or without biopsy 30 ‫يساهم الصندوق‬
39501 Repair of diaphragmatic laceration, any approach 90 ‫يساهم الصندوق‬
Repair, paraesophageal hiatus hernia, transabdominal, with or without
funduloplasty, vagotomy, and/or pyloroplasty, except neonatal
Repair, neonatal diaphragmatic hernia, with or without chest tube
insertion, with or without creation of ventral hernia
39520 Repair of diaphragmatic hernia, (except neonatal): any approach 100 ‫يساهم الصندوق‬
Imbrication of diaphragm for eventration, transthoracic or
transabdominal, paralytic or nonparalytic
40490 Biopsy of lip (separate procedure) 10 ‫يساهم الصندوق‬
40500 Vermilionectomy with mucosal advancement 30 ‫يساهم الصندوق‬
40510 Excision of lip: transverse wedge excision with primary closure 30 ‫يساهم الصندوق‬
40520 Excision of lip: V-excision with primary direct linear closure 30 ‫يساهم الصندوق‬
40525 Excision of lip: full thickness, reconstruction with any flap 60 ‫يساهم الصندوق‬
40530 Resection of lip, more than one-fourth, without reconstruction 30 ‫يساهم الصندوق‬
40650 Repair of lip, full thickness: any part 30 ‫يساهم الصندوق‬
Plastic repair of cleft lip/nasal deformity: primary, partial or complete,
unilateral
Plastic repair of cleft lip/nasal deformity: primary bilateral, one stage
procedure
Plastic repair of cleft lip/nasal deformity: primary bilateral, two stages,
per stage
Plastic repair of cleft lip/nasal deformity: secondary, by recreation of
defect and reclosure
Plastic repair of cleft lip/nasal deformity: with cross lip pedicle flap
(Abbe-Estlander type), including sectioning and insertion of pedicle
40806 Incision of labial frenum (frenotomy) 15 ‫يساهم الصندوق‬
40808 Biopsy, vestibule of mouth 15 ‫يساهم الصندوق‬
Excision of lesion of mucosa and submucosa, vestibule of mouth: without
repair
Excision of lesion of mucosa and submucosa of vestibule of mouth: with
repair
Excision of lesion of mucosa and submucosa, vestibule of mouth:
complex with excision of underlying muscle
40818 Excision of mucosa of vestibule of mouth as donor graft 15 ‫يساهم الصندوق‬
Excision of frenum, labial or buccal (frenumectomy, frenulectomy,
frenectomy)
Destruction of lesion or scar of vestibule of mouth by physical methods
(eg, laser, thermo, cryo, chemical)
40830 Closure of laceration, vestibule of mouth 15 ‫يساهم الصندوق‬
40840 Vestibuloplasty: anterior and/or posterior; unilateral or bilateral 40 ‫يساهم الصندوق‬
Vestibuloplasty: entire arch or complex (including ridge extension,
muscle repositioning)
Intraoral incision and drainage of abscess, cyst, or hematoma of tongue or
41000 floor of mouth: lingual, sublingual, supramylohyoid or submental or 15 ‫يساهم الصندوق‬
submandibular space
41010 Incision of lingual frenum (frenotomy) 15 ‫يساهم الصندوق‬
Extraoral incision and drainage of abscess, cyst, or hematoma of floor of
mouth: sublingual, submental, submandibular or masticator space
41100 Biopsy of tongue: any part (separate procedure) 20 ‫يساهم الصندوق‬
41108 Biopsy of floor of mouth (separate procedure) 20 ‫يساهم الصندوق‬
Excision of lesion of tongue with or without closure: any part (separate
procedure)
Excision of lesion of tongue with closure: with local tongue flap (separate
procedure)
41115 Excision of lingual frenum (frenectomy) 20 ‫يساهم الصندوق‬
41116 Excision, lesion floor of mouth 20 ‫يساهم الصندوق‬
41120 Glossectomy: partial 50 ‫يساهم الصندوق‬
41135 Glossectomy: partial or total, with unilateral radical neck dissection 150 ‫يساهم الصندوق‬
41250 Repair of laceration : floor of mouth and/or tongue 20 ‫يساهم الصندوق‬
41500 Mechanical fixation of tongue other than suture (eg, K-wire) 20 ‫يساهم الصندوق‬
41510 Suture of tongue to lip for micrognathia (Douglas type procedure) 20 ‫يساهم الصندوق‬
41520 Frenoplasty (surgical revision of frenum, eg, with Z-plasty) 25 ‫يساهم الصندوق‬
Excision of lesion or tumor, dentoalveolar structures: with or without
repair
42000 Drainage of abscess of palate, uvula (separate procedure) 15 ‫يساهم الصندوق‬
Biopsy or excision, lesion of palate, uvula: with or without closure
42107 Excision, lesion of palate, uvula: with local flap closure 30 ‫يساهم الصندوق‬
42120 Resection of palate or extensive resection of lesion (separate procedure) 40 ‫يساهم الصندوق‬
42140 Uvulectomy 10 ‫يساهم الصندوق‬
42145 Palatopharyngoplasty (uvulopalatopharyngoplasty, uvulopharyngoplasty) 60 ‫يساهم الصندوق‬
42180 Repair, laceration of palate 15 ‫يساهم الصندوق‬
Repair of hard and/or soft palate (palatoplasty) for cleft palate,
lengthening, or repair of anterior palate: any method
42260 Repair of nasolabial fistula 30 ‫يساهم الصندوق‬
Drainage of abscess: parotid, submaxillary or sublingual gland (separate
procedure)
42325 Fistulization of sublingual salivary cyst 20 ‫يساهم الصندوق‬
42330 Sialolithotomy: submaxillary, sublingual or parotid, office procedure 20 ‫يساهم الصندوق‬
42340 Sialolithotomy: parotid, extraoral 30 ‫يساهم الصندوق‬
42400 Biopsy of salivary gland: needle (separate procedure) 5 ‫يساهم الصندوق‬
42405 Biopsy of salivary gland: incisional (separate procedure) 20 ‫يساهم الصندوق‬
42408 Excision of sublingual cyst (ranula) (separate procedure) 30 ‫يساهم الصندوق‬
42409 Marsupialization of sublingual salivary cyst (ranula) (separate procedure) 20 ‫يساهم الصندوق‬
Excision of parotid tumor or parotid gland: lateral lobe, with or without
dissection and preservation of facial nerve
Excision of parotid gland: total, with dissection and preservation of facial
nerve
Excision of parotid gland: total en bloc removal with sacrifice of facial
nerve
42426 Excision of parotid gland: total, with unilateral radical neck dissection 100 ‫يساهم الصندوق‬
42440 Excision of submandibular (submaxillary) tumor and/or gland 45 ‫يساهم الصندوق‬
42450 Excision of sublingual gland 30 ‫يساهم الصندوق‬
42500 Plastic repair of salivary duct, sialodochoplasty: primary or simple 30 ‫يساهم الصندوق‬
42505 Plastic repair of salivary duct, sialodochoplasty: secondary or complicated 40 ‫يساهم الصندوق‬
42507 Parotid duct diversion, bilateral (Wilke type procedure) 40 ‫يساهم الصندوق‬
Parotid duct diversion, bilateral: with excision of one or both
submandibular glands
Parotid duct diversion, bilateral: with ligation of both submandibular
(Wharton's) ducts
42550 Injection procedure for sialography (separate procedure) 10 ‫يساهم الصندوق‬
42600 Closure of salivary fistula 30 ‫يساهم الصندوق‬
Incision and drainage abscess: retropharyngeal or parapharyngeal,
intraoral approach (separate procedure)
Incision and drainage abscess: peritonsillar retropharyngeal or
parapharyngeal, external approach (separate procedure)
42800 Biopsy: oropharynx, hypopharynx or nasopharynx (separate procedure) 15 ‫يساهم الصندوق‬
Excision branchial cleft cyst or vestige, confined to skin and
subcutaneous tissues
Excision branchial cleft cyst, vestige, or fistula, extending beneath
subcutaneous tissues and/or into pharynx
Tosillectomy and adenoidectomy, including treatment of postoperative
complications: any age
42830 Adenoidectomy (separate procedure): primary or secondary 20 ‫يساهم الصندوق‬
Radical resection of tonsil, tonsillar pillars, and/or retromolar trigone:
without closure
Radical resection of tonsil, tonsillar pillars, and/or retromolar trigone:
closure with local flap (eg, tongue, buccal) or other flap
42860 Excision of tonsil tag(s) 15 ‫يساهم الصندوق‬
42870 Excision or destruction of lingual tonsil, any method (separate procedure) 35 ‫يساهم الصندوق‬
42880 Excision of nasopharyngeal lesion (eg, fibroma) 40 ‫يساهم الصندوق‬
42900 Suture of wound or injury of pharynx 35 ‫يساهم الصندوق‬
42950 Pharyngoplasty 55 ‫يساهم الصندوق‬
42953 Pharyngoesophageal repair 55 ‫يساهم الصندوق‬
42955 Pharyngostomy (fistulization of pharynx, external for feeding) 45 ‫يساهم الصندوق‬
Control oropharyngeal or nasopharyngeal hemorrhage, primary or
secondary (eg, post-tonsillectomy): simple
Control oropharyngeal or nasopharyngeal hemorrhage, primary or
secondary: complicated, requiring hospitalization
Control oropharyngeal or nasoppharyngeal hemorrhage, primary or
secondary: with secondary surgical intervention (separate procedure)
Esophagotomy, cervical approach: with or without removal of foreign
body
43030 Cricopharyngeal myotomy 50 ‫يساهم الصندوق‬
Esophagotomy, thoracic approach, for biopsy, removal of foreign body,
or diverticulum
Esophagectomy, partial or total, with or without anastomosis and or
reconstruction, any approach, any method
43120 Esophagogastrectomy, thoracoabdominal approach 180 ‫يساهم الصندوق‬
Diverticulectomy of hypopharynx or esophagus, with or without
myotomy: cervical approach
Diverticulectomy of hypopharynx or esophagus, with or without
myotomy: thoracic approach
Esophagoscopy, rigid or flexible fiberoptic: diagnostic (separate
procedure)
43205 Esophagoscopy, rigid or flexible fiberoptic: therapeutic 30 ‫يساهم الصندوق‬
Upper gastrointestinal endoscopy (esophagus, stomach, and either the
duodenum and/or jejunum as appropriate): diagnostic (separate procedure)
Upper gastrointestinal endoscopy (esophagus, stomach, and either the
duodenum and/or jejunum as appropriate): therapeutic
Endoscopic retrograde cholangiopancreatography (ERCP) diagnostic
Endoscopic retrograde cholangiopancreatography (ERCP) therapeutic
Esophagoplasty (plastic repair or reconstruction), cervical approach:
without repair of tracheoesophageal fistula
Esophagoplasty (plastic repair or reconstruction), cervical approach: with
repair of tracheoesophageal fistula
Esophagoplasty (plastic repair or reconstruction), thoracic approach:
without repair of tracheoesophageal fistula
Esophagoplasty (plastic repair or reconstruction), thoracic approach: with
repair of tracheoesophageal fistula
Esophagogastrostomy (cardioplasty) with or without vagotomy and
pyloroplasty: abdominal or thoracic approach
Fundoplication for gastroesophageal reflux or hiatus hernia eg. Nissen,
Belsey IV, or Hill procedure, (any approach)
Esophagomyotomy (Heller type),with or without hiatal hernia repair:
abdominal or thoracic approach
43340 Esophagojejunostomy (without total gastrectomy) 100 ‫يساهم الصندوق‬
43350 Esophagostomy 70 ‫يساهم الصندوق‬
43400 Direct ligation of esophageal varices 100 ‫يساهم الصندوق‬
43410 Suture of esophageal wound or injury: cervical approach 70 ‫يساهم الصندوق‬
43415 Suture of esophageal wound or injury: thoracic approach 100 ‫يساهم الصندوق‬
43420 Closure of esophagostomy or fistula 70 ‫يساهم الصندوق‬
Dilation of esophagus, by unguided sound or bougie, single or multiple
passes (separate procedure)
43456 Dilation of esophagus, by balloon or dilator: retrograde 15 ‫يساهم الصندوق‬
Dilation of esophagus for achalasia (balloon 30 mm or larger) (separate
procedure)
Esophagogastric tamponade, with balloon (Sengstaaken type) (separate
procedure)
43500 Gastrotomy: with exploration or removal of foreign body 70 ‫يساهم الصندوق‬
43520 Pyloromyotomy (Fredet-Ramstedt type operation) 70 ‫يساهم الصندوق‬
Biopsy of stomach: by capsule, tube, peroral (one or more specimens)
43605 Biopsy of stomach: by laparatomy (separate procedure) 60 ‫يساهم الصندوق‬
43610 Local excision of stomach ulcer or tumor 70 ‫يساهم الصندوق‬
Gastrectomy, total: with repair by intestinal transplant, without
lymphadenectomy
Gastrectomy, total: with repair by intestinal transplant, with
lymphadenectomy
Hemigastrectomy: distal subtotal gastrectomy including pyloroplasty,
gastroduodenostomy or gastrojejunostomy: with or without vagotomy
Hemigastrectomy: proximal subtotal gastrectomy including pyloroplasty,
gastroduodenostomy or gastrojejunostomy: with or without vagotomy
Vagotomy including pyloroplasty, with or without gastrostomy: truncal or
selective or highly selective
Percutaneous and/or endoscopic placement of gastrostomy tube (separate
procedure)
43760 Change of gastrostomy tube (separate procedure) 15 ‫يساهم الصندوق‬
Repositioning of the gastric feeding tube through the duodenum for
enteric nutrition (separate procedure)
43800 Pyloroplasty 70 ‫يساهم الصندوق‬
43810 Gastroduodenostomy or gastrojejunostomy, 70 ‫يساهم الصندوق‬
43825 Gastrojejunostomy with vagotomy, any type 115 ‫يساهم الصندوق‬
43830 Gastrostomy 70 ‫يساهم الصندوق‬
43832 Gastrostomy, permanent, with construction of gastric tube 70 ‫يساهم الصندوق‬
43840 Gastrorrhaphy 70 ‫يساهم الصندوق‬
Gastric restrictive procedure with or without bypass for morbid obesity,
any method
Revision of gastrojejunostomy with reconstruction, with or without
vagotomy
43870 Closure of gastrostomy, surgical 60 ‫يساهم الصندوق‬
43880 Closure of gastrocolic fistula 115 ‫يساهم الصندوق‬
44005 Enterolysis with acute bowel obstruction (separate procedure) 80 ‫يساهم الصندوق‬
Enterotomy, small bowel other than duodenum: for exploration, biopsy,
or foreign body removal (separate procedure)
44050 Reduction of volvulus, intussusception, internal hernia, by laparatomy 70 ‫يساهم الصندوق‬
44100 Biopsy of intestine by capsule, tube, peroral (one or more specimens) 20 ‫يساهم الصندوق‬
Excision of one or more lesions of small or large bowel not requiring
44110 anastomosis, exteriorization, or fistulization: single or multiple 80 ‫يساهم الصندوق‬
enterotomies
44120 Enterectomy: with anastomosis 95 ‫يساهم الصندوق‬
Colectomy, partial: with anastomosis or skin level cecostomy or
colostomy
Colectomy, partial: with colpoproctostomy (low pelvic anastomosis),
with or without colostomy
Colectomy, total, abdominal, without proctectomy: with continent
ileostomy or ileoproctostomy
Colectomy, total or subtotal, with proctectomy: with rectal mucosectomy,
44153 ileoanal or coloanal anastomosis, creation of reservoir (S or J), with or 180 ‫يساهم الصندوق‬
without loop ileostomy or colostomy
44156 Colectomy, total, abdominal, with proctectomy: with continent ileostomy 140 ‫يساهم الصندوق‬
44157 Laparatomy for newborn intestinal occlusion 130 ‫يساهم الصندوق‬
Enterostomy or cecostomy, tube (eg, for decompression or feeding)
44310 Ileostomy or jejunostomy, non-tube (separate procedure) 75 ‫يساهم الصندوق‬
44320 Colostomy or skin level cecostomy (separate procedure) 75 ‫يساهم الصندوق‬
44321 Colostomy in newborn 85 ‫يساهم الصندوق‬
Revision of colostomy: simple (release of superficial scar) (separate
procedure)
44345 Reconstruction of colostomy (separate procedure) 70 ‫يساهم الصندوق‬
Small intestine endoscopy, enteroscopy beyond second portion of
duodenum: diagnostic or therapeutic (separate procedure)
Fiberoptic ileoscopy through stoma: diagnostic, with/without biopsy
44380 and/or collection of specimen by brushing or washing (separate 15 ‫يساهم الصندوق‬
procedure)
Fiberoptic ileoscopy through stoma: with biopsy and/or collection of
specimen by brushing or washing (separate procedure)
Fiberoptic evaluation of small intestinal or pelvic pouch: diagnostic, with
44385 or without biopsy and/or collection of specimen by brushing or washing 15 ‫يساهم الصندوق‬
Fiberoptic colonoscopy through colostomy: diagnostic or therapeutic
Suture of intestine , large or small, for perforated ulcer, diverticulum,
wound, injury or rupture, single or multiple
Closure of enterostomy, large or small intestine: with or without
resection and anastomosis
44626 Closure of colostomy (under age 2 years) 85 ‫يساهم الصندوق‬
44640 Closure of intestinal cutaneous fistula 80 ‫يساهم الصندوق‬
44650 Closure of enteroenteric or enterocolic fistula 90 ‫يساهم الصندوق‬
44660 Closure of enterovesical fistula 95 ‫يساهم الصندوق‬
44800 Excision of Meckel's diverticulum or omphalomesenteric duct 70 ‫يساهم الصندوق‬
44820 Excision of benign lesion of mesentery (separate procedure) 60 ‫يساهم الصندوق‬
44821 Excision of malignant lesion of mesentery (separate procedure) 90 ‫يساهم الصندوق‬
44850 Suture of mesentery (separate procedure) 60 ‫يساهم الصندوق‬
44950 Appendectomy, any method (non-incidental procedure) 60 ‫يساهم الصندوق‬
45000 Transrectal drainage of pelvic abscess (separate procedure) 25 ‫يساهم الصندوق‬
Incision and drainage of deep supralevator, pelvirectal, or retrorectal
abscess
Biopsy of anorectal wall, anal approach (eg, congenital megacolon)
45108 Anorectal myomectomy for short segment megacolon 50 ‫يساهم الصندوق‬
Proctectomy: complete, combined abdominoperineal, with colostomy,
one or two stages
Proctectomy, complete: (eg, for congenital megacolon, Swenson,
Duhamel, or Soave type operation)
Excision of rectal procidentia with anastomosis: abdominal and/or
perineal approach
45150 Division of stricture of rectum (separate procedure) 35 ‫يساهم الصندوق‬
Excision of rectal tumor by proctotomy, transacral or transcoccygeal
approach
45170 Excision of rectal tumor, transanal approach 50 ‫يساهم الصندوق‬
Proctosigmoidoscopy: diagnostic with or without biopsy (separate
procedure)
45330 Sigmoidoscopy, therapeutic (separate procedure) 30 ‫يساهم الصندوق‬
Colonoscopy, with standard sigmoidoscope, transabdominal via
colotomy, single or multiple (separate procedure)
45378 Colonoscopy, fiberoptic, beyond splenic flexure: diagnostic 40 ‫يساهم الصندوق‬
45383 Colonoscopy, fiberoptic, beyond splenic flexure: therapeutic 45 ‫يساهم الصندوق‬
45505 Proctoplasty: for prolapse of mucous membrane or stenosis 50 ‫يساهم الصندوق‬
45520 Perirectal injection of sclerosing solution for prolapse 15 ‫يساهم الصندوق‬
45540 Proctopexy for prolapse: abdominal or perineal approach 100 ‫يساهم الصندوق‬
Closure of rectovesical fistula or rectourethral fistula: with or wihtout
colostomy
45905 Dilation of anal or rectal sphincter (separate procedure) under anesthesia 15 ‫يساهم الصندوق‬
45915 Removal of impacted feces or foreign body (separate procedure) 15 ‫يساهم الصندوق‬
Incision and drainage of ischiorectal, perirectal or perianal abscess
Incision and drainage of ischiorectal or intramural abscess, with
fistulectomy, submuscular
46070 Incision, anal septum (infant) 30 ‫يساهم الصندوق‬
46080 Sphincterotomy, anal (separate procedure) 30 ‫يساهم الصندوق‬
46200 Fissurectomy, with or without sphincterotomy 35 ‫يساهم الصندوق‬
46260 Hemorrhoidectomy, external and/or internal 45 ‫يساهم الصندوق‬
Hemorrhoidectomy, internal and external: with fistulectomy and/or
fissurectomy
Surgical treatment of anal fistula: fistulotomy / fistulectomy (separate
procedure)
46500 Injection of sclerosing solution, hemorrhoids (separate procedure) 15 ‫ال يساهم الصندوق‬
46600 Anoscopy: diagnostic (separate procedure) 5 ‫يساهم الصندوق‬
46610 Anoscopy: therapeutic (separate procedure) 15 ‫يساهم الصندوق‬
46700 Anoplasty, for stricture (separate procedure) 55 ‫يساهم الصندوق‬
46715 Repair of congenital anovaginal fistula (cutback like procedure) 55 ‫يساهم الصندوق‬
Construction of anus for high congenital absence: perineal or
sacrococcygeal approach or abdomino-perineal approach
46750 Sphincteroplasty, anal, for incontinence or prolapse 65 ‫يساهم الصندوق‬
46760 Sphincteroplasty, anal, for incontinence: muscle transplant 150 ‫يساهم الصندوق‬
Destruction of internal or external hemorrhoids or of lesion(s) of anus,
any method (eg. Banding, sclerotherapy, cryotherapy, laser or other)
46937 Cryosurgery of rectal tumor: benign (separate procedure) 20 ‫يساهم الصندوق‬
46938 Cryosurgery of rectal tumor: malignant (separate procedure) 30 ‫يساهم الصندوق‬
Curettage or cauterization of anal fissure, including dilation of anal
sphincter (separate procedure)
46945 Ligation of internal hemorrhoids (separate procedure) 20 ‫يساهم الصندوق‬
47000 Biopsy of liver, percutaneous needle (separate procedure) 15 ‫يساهم الصندوق‬
47010 Hepatotomy for drainage of abscess or cyst, one or two stages 65 ‫يساهم الصندوق‬
47100 Biopsy of liver, wedge (separate procedure) 65 ‫يساهم الصندوق‬
47101 Transjugular liver biopsy 65 ‫يساهم الصندوق‬
47102 Transjugular intrahepatic porto-systemic shunt 75 ‫يساهم الصندوق‬
47120 Hepatectomy: partial lobectomy 130 ‫يساهم الصندوق‬
47122 Hepatectomy: trisegmentectomy 200 ‫يساهم الصندوق‬
47125 Hepatectomy: total left lobectomy 200 ‫يساهم الصندوق‬
47130 Hepatectomy: total right lobectomy 200 ‫يساهم الصندوق‬
Donor hepatectomy, with preparation and maintenance of allograft: from
cadaver donor
Donor hepatectomy, with preparation and maintenance of allograft:
partial, from living donor
Liver allotransplantation: orthotopic, partial or whole, from cadaver or
living donor, any age
Liver allotransplantation: heterotopic, partial or whole, from cadaver or
living donor, any age
47300 Marsupialization of cyst or abscess of liver 70 ‫يساهم الصندوق‬
47320 Evacuation of hydatid cyst, single, any method 75 ‫يساهم الصندوق‬
47325 Evacuation of hydatid cyst, multiple, any method 90 ‫يساهم الصندوق‬
Management of liver hemorrhage: hepatorrhaphy, with or without ligation
of hepatic artery
Hepaticotomy or hepaticostomy with exploration, drainage, or removal of
calculus
Choledochotomy or choledochostomy with exploration, drainage, or
47425 removal of calculus, with or without cholecystotomy: with or without 110 ‫يساهم الصندوق‬
transduodenal sphincterotomy or sphincteroplasty
47460 Transduodenal sphincterotomy or sphincteroplasty (separate procedure) 110 ‫يساهم الصندوق‬
Cholecystotomy or cholecystostomy with exploration, drainage, or
removal of calculus (separate procedure)
47500 Injection procedure for percutaneous transhepatic cholangiography 20 ‫يساهم الصندوق‬
47510 Introduction of percutaneous transhepatic catheter for biliary drainage 50 ‫يساهم الصندوق‬
47511 Introduction of transhepatic stent for internal and external biliary drainage 55 ‫يساهم الصندوق‬
47525 Change of percutaneous biliary drainage catheter (separate procedure) 20 ‫يساهم الصندوق‬
47530 Revision and/or reinsertion of transhepatic T-tube (separate procedure) 30 ‫يساهم الصندوق‬
47600 Cholecystectomy: with or without cholangiography, any method 80 ‫يساهم الصندوق‬
47610 Cholecystectomy: with exploration of common duct 110 ‫يساهم الصندوق‬
Cholecystectomy: with transduodenal sphincterotomy or
sphincteroplasty, with or without cholangiography
47630 Percutaneous stone extraction by basketing 50 ‫يساهم الصندوق‬
Exploration for congenital atresia of bile ducts, without repair, with or
without liver biopsy, with or without cholangiography
47701 Portoenterostomy (eg, Kasai procedure) 180 ‫يساهم الصندوق‬
47720 Cholecystoenterostomy: direct (any method) 80 ‫يساهم الصندوق‬
47760 Anastomosis, direct, of extrahepatic biliary ducts and gastrointestinal tract 130 ‫يساهم الصندوق‬
47765 Anastomosis, direct, of intrahepatic ducts and gastrointestinal tract 140 ‫يساهم الصندوق‬
Reconstruction, plastic, of extrahepatic biliary ducts with end-to-end
anastomosis
47801 Placement of choledochal stent (separate procedure) 80 ‫يساهم الصندوق‬
48000 Drainage of abdomen for pancreatitis (separate procedure) 80 ‫يساهم الصندوق‬
48100 Biopsy of pancreas (separate procedure) 70 ‫يساهم الصندوق‬
48102 Biopsy of pancreas, percutaneous needle 15 ‫يساهم الصندوق‬
48120 Excision of lesion of pancreas (eg, cyst, adenoma) 90 ‫يساهم الصندوق‬
Pancreatectomy, distal subtotal, with or without splenectomy: with or
without pancreaticojejunostomy
Pancreatectomy,proximal subtotal, with pancreaticoduodenectomy
(Whipple type procedure), and pancreatic jejunostomy
48155 Pancreatectomy,total 190 ‫يساهم الصندوق‬
Pancreaticojejunostomy, side-to-side anastomosis (Puestow type
operation)
48500 Marsupialization of cyst of pancreas 80 ‫يساهم الصندوق‬
48520 Internal anastomosis of pancreatic cyst to gastro-intestinal tract: direct 90 ‫يساهم الصندوق‬
Internal anastomosis of pancreatic cyst to gastrointestinal tract: Roux-en-
Y
Exploratory laparatomy, exploratory celiotomy, with or without biopsy
49002 Reopening of recent laparatomy (separate procedure) 70 ‫يساهم الصندوق‬
Exploration of retroperitoneal area with or without biopsy (separate
procedure)
Drainage of peritoneal abscess or localizd peritonitis, transabdominal
49040 Drainage of subdiaphragmatic or subphrenic abscess (separate procedure) 70 ‫يساهم الصندوق‬
49060 Drainage of retroperitoneal abscess (separate procedure) 70 ‫يساهم الصندوق‬
Peritoneocentesis, abdominal paracentesis or peritoneal lavage
(diagnostic or therapeutic)
49180 Biopsy, abdominal or retroperitoneal mass, percutaneous needle 15 ‫يساهم الصندوق‬
Excision or destruction by any method of intra-abdominal or
retroperitoneal tumors or cysts or endometriomas
Excision or destruction by any method of intra-abdominal or
retroperitoneal tumors or cysts or endometriomas: extensive
49215 Excision of presacral or sacrococcygeal tumor 110 ‫يساهم الصندوق‬
Staging celiotomy for Hodgkin's or lymphoma (includes splenectomy,
49220 biopsies of liver lobes, and possible removal of abdominal nodes, 110 ‫يساهم الصندوق‬
abdominal node and/or bone marrow biopsies, ovarian repositioning)
49255 Omentectomy, epiploectomy, resection of omentum (separate procedure) 70 ‫يساهم الصندوق‬
49400 Pneumoperitoneum 15 ‫يساهم الصندوق‬
49420 Insertion of intraperitoneal cannula or catheter 15 ‫يساهم الصندوق‬
49425 Insertion of peritoneal-venous shunt (eg, LeVeen shunt) 70 ‫يساهم الصندوق‬
49426 Revision of peritoneal-venous shunt 60 ‫يساهم الصندوق‬
Injection procedure (eg, contrast media) for evaluation of previously
placed peritoneal-venous shunt
Repair initial inguinal hernia, under age 5 years, with or without
hydrocelectomy
Repair inguinal hernia, age 5 years or over, initial, recurrent, or sliding,
with or without prosthesis, with or without hydrocelectomy
49550 Repair femoral, umbilical, or lumbar hernia, any age, initial 55 ‫يساهم الصندوق‬
Repair femoral, umbilical, or lumbar hernia, any age, recurrent, with or
without prosthesis
Repair incisional (abdominal) hernia, reducible, with or without
prosthesis: initial separate procedure)
Repair incisional (abdominal) hernia, reducible, with or without
prosthesis: recurrent, with total abdominal repair
49590 Repair spigelian hernia 55 ‫يساهم الصندوق‬
49600 Repair of omphalocele: small, with primary closure 55 ‫يساهم الصندوق‬
49605 Repair of omphalocele: large or gastroschisis, with or without prosthesis 110 ‫يساهم الصندوق‬
Repair of omphalocele: with staged closure of prosthesis, reduction in
operating room, under anesthesia
49610 Repair of omphalocele (Gross type operation): first stage 70 ‫يساهم الصندوق‬
49611 Repair of omphalocele (Gross type operation): second stage 55 ‫يساهم الصندوق‬
49900 Secondary suture of abdominal wall for evisceration or dehiscence 55 ‫يساهم الصندوق‬
Omental flap (eg, for reconstruction of sternal and chest wall defects (list
separately in addition to code for primary procedure)
50020 Drainage of perirenal or renal abscess (separate procedure) 70 ‫يساهم الصندوق‬
50040 Nephrostomy, nephrotomy with drainage 70 ‫يساهم الصندوق‬
50045 Nephrotomy, with exploration 80 ‫يساهم الصندوق‬
50060 Nephrolithotomy 110 ‫يساهم الصندوق‬
50065 Nephrolithotomy: secondary surgical operation for calculus 120 ‫يساهم الصندوق‬
50070 Nephrolithotomy: complicated by congenital kidney abnormality 115 ‫يساهم الصندوق‬
Nephrolithotomy: removal of large staghorn calculus filling renal pelvis
and calyces (including anatrophic pyelolithotomy)
Percutaneous nephrostolithotomy or pyelostolithotomy, with or without
dilation, endoscopy, lithotripsy, stenting or basket extraction
50100 Transection or repositioning of aberrant renal vessels (separate procedure) 90 ‫يساهم الصندوق‬
50125 Pyelotomy: with exploration, drainage, pyelostomy 90 ‫يساهم الصندوق‬
Pyelotomy: with removal of calculus (pyelolithotomy, pelviolithotomy,
including coagulum pyelolithotomy)
Pyelotomy: complicated (eg, secondary operation, congenital kidney
abnormality)
50200 Renal biopsy: percutaneous, by trocar or needle 20 ‫يساهم الصندوق‬
50205 Renal biopsy: by surgical exposure of kidney 75 ‫يساهم الصندوق‬
Nephrectomy, including partial ureterectomy, any approach including rib
resection
Nephrectomy, including partial ureterectomy, any approach including rib
50230 resection: radical, with regional lymphadenectomy and/or vena caval 140 ‫يساهم الصندوق‬
thrombectomy
50234 Nephrectomy, with total ureterectomy and bladder cuff 140 ‫يساهم الصندوق‬
50240 Nephrectomy, partial 100 ‫يساهم الصندوق‬
50280 Excision or unroofing of cyst(s) of kidney 75 ‫يساهم الصندوق‬
50290 Excision of perinephric cyst 75 ‫يساهم الصندوق‬
Donor nephrectomy, with preparation and maintenance of homograft:
from live donor, unilateral
50340 Recipient nephrectomy (separate procedure), bilateral 100 ‫يتطلب موافقة‬
Renal homotransplantation, implantation of graft: excluding donor and
recipient nephrectomy
Renal homotransplantation, implantation of graft: with recipient
nephrectomy
50370 Removal of transplanted homograft (eg, infarcted or rejected kidney) 90 ‫يتطلب موافقة‬
50380 Renal autotransplantation, reimplantation of kidney 130 ‫يتطلب موافقة‬
50390 Aspiration and/or injection of renal cyst or pelvis by needle, percutaneous 20 ‫يساهم الصندوق‬
Introduction of intracatheter or catheter into renal pelvis for drainage
and/or injection, percutaneous
Introduction of ureteral catheter or stent into ureter through renal pelvis
for drainage and/or injection, percutaneous
Injection procedure for pyelography through nephrostomy or pyelostomy
tube, or indwelling catheter
Introduction of guide into renal pelvis and/or ureter with dilation to
establish nephrostomy tract, percutaneous
Manometric studies through nephrostomy or pyelostomy tube, or
indwelling catheter
50398 Change of nephrostomy or pyelostomy tube 10 ‫يساهم الصندوق‬
Pyeloplasty (Foley Y-pyeloplasty), with or without plastic operation on
ureter, nephropexy, nephrostomy, pyelostomy, or ureteral splinting
50500 Nephrorrhaphy, suture of kidney wound or injury 100 ‫يساهم الصندوق‬
50520 Closure of nephrocutaneous or pyelocutaneous fistula 90 ‫يساهم الصندوق‬
50525 Closure of nephrovisceral fistula (eg, renocolic), including visceral repair 100 ‫يساهم الصندوق‬
Symphysiotomy for horseshoe kidney with or without pyeloplasty and/or
other plastic procedure, unilateral or bilateral (one operation)
Renal endoscopy through established nephrostomy or pyelostomy,
diagnostic or therapeutic
50590 Lithotripsy, extracorporeal shock wave 65 ‫يتطلب موافقة‬
50600 Ureterotomy with exploration or drainage (separate procedure) 70 ‫يساهم الصندوق‬
50605 Ureterotomy for insertion of indwelling stent, all types 70 ‫يساهم الصندوق‬
50610 Ureterolithotomy 70 ‫يساهم الصندوق‬
50650 Ureterectomy, with bladder cuff (separate procedure) 95 ‫يساهم الصندوق‬
Ureterectomy, total, ectopic ureter, combination abdominal, vaginal
and/or perineal approach
Injection procedure for ureterography or ureteropyelography through
ureterostomy or indwelling ureteral catheter
50686 Manometric studies through ureterostomy or indwelling ureteral catheter 10 ‫يساهم الصندوق‬
50688 Change of ureterostomy tube 10 ‫يساهم الصندوق‬
Injection procedure for visualization of ilial conduit and/or
ureteropyelography exclusive of radiologic service
50700 Ureteroplasty, plastic operation on ureter (eg, stricture) 100 ‫يساهم الصندوق‬
Ureterolysis, with or without repositioning of ureter for retroperitoneal
fibrosis or for ovarian vein sydrome
Ureterolysis, for retrocaval ureter, with reanastomosis of upper urinary
tract or vena cava
Revision of urinary-cutaneous anastomosis (any type urostomy): with or
without repair of fascial defect and hernia
50740 Ureteropyelostomy, anastomosis of ureter and renal pelvis or calyx 110 ‫يساهم الصندوق‬
50760 Uretero-ureterostomy 100 ‫يساهم الصندوق‬
50770 Transureteroureterostomy, anastomosis of ureter to contralateral ureter 115 ‫يساهم الصندوق‬
50780 Ureteroneocystostomy, anastomosis of single ureter to bladder 100 ‫يساهم الصندوق‬
50782 Ureteroneocystostomy, anastomosis of duplicated ureter to bladder 115 ‫يساهم الصندوق‬
Ureteroneocystostomy, anastomosis of ureter to bladder, with vesico-
psoas hitch or bladder flap
50800 Ureteroenterostomy, direct anastomosis of ureter to intestine 90 ‫يساهم الصندوق‬
Ureterosigmoidostomy, with creation of sigmoid bladder and
50810 establishment of abdominal or perineal colostomy, including bowel 120 ‫يساهم الصندوق‬
anastomosis
50815 Ureterocolon conduit, including bowel anastomosis 120 ‫يساهم الصندوق‬
Ureteroileal conduit (ileal bladder), including bowel anastomosis (Bricker
operation)
Continent diversion, including bowel anastomosis using any segment of
small and/or large bowel (Kock pouch or Camey enterocystoplasty)
Urinary undiversion (eg, taking down of ureteroileal conduit,
50830 ureterosigmoidostomy or ureteroenterostomy with ureteroenterostomy or 160 ‫يساهم الصندوق‬
ureteroneocystostomy)
Replacement of all or part of ureter by bowel segment, including bowel
anastomosis
50860 Ureterostomy, transplantation of ureter to skin 80 ‫يساهم الصندوق‬
50900 Ureterorrhaphy (separate procedure) 80 ‫يساهم الصندوق‬
50920 Closure of ureterocutaneous fistila 80 ‫يساهم الصندوق‬
50930 Closure of ureterovesical fistula, (including visceral repair) 95 ‫يساهم الصندوق‬
50940 Deligation of ureter 70 ‫يساهم الصندوق‬
Ureteral endoscopy through established ureterostomy diagnostic or
therapeutic
51005 Aspiration of bladder: by trocar, intracatheter or needle 10 ‫يساهم الصندوق‬
51010 Aspiration of bladder with insertion of suprapubic catheter 20 ‫يساهم الصندوق‬
Cystotomy or cystostomy: with fulguration and/or insertion of radioactive
material
Cystotomy or cystostomy: with cryosurgical destruction of intravesical
lesion
51040 Cystostomy, cystotomy with drainage 40 ‫يساهم الصندوق‬
Cystotomy, with insertion of ureteral catheter or stent (separate
procedure)
Cystolithotomy, cystotomy with removal of calculus: without vesical
neck dissection
51060 Transvesical ureterolithotomy 45 ‫يساهم الصندوق‬
Cystotomy, with stone basket extraction and/or ultrasonic or
electrohydraulic fragmentation of ureteral calculus
51080 Drainage of perivesical or prevesical space abscess 25 ‫يساهم الصندوق‬
51500 Excision of urachal cyst or sinus, with or without umbilical hernia repair 50 ‫يساهم الصندوق‬
51520 Cystotomy: for simple excision of vesical neck (separate procedure) 60 ‫يساهم الصندوق‬
Cystotomy: for excision of bladder diverticulum, single or multiple
51530 Cystotomy: for excision of bladder tumor 75 ‫يساهم الصندوق‬
51535 Cystotomy for excision, incision, or repair of ureterocele 75 ‫يساهم الصندوق‬
51550 Cystectomy, partial 105 ‫يساهم الصندوق‬
Cystectomy, partial, with reimplantation of ureter(s) into bladder
(ureteroneocystostomy)
Cystectomy, complete: with bilateral pelvic lymphadenectomy, including
external iliac, hypogastric and obturator nodes
Cystectomy, complete, with ureterosigmoidostomy or ureterocutaneous
transplantations
Cystectomy, complete, with ureterosigmoidostomy or ureterocutaneous
51585 transplants: with bilateral pelvic lymphadenectomy, including iliac, 220 ‫يساهم الصندوق‬
hypogastric and obturator nodes
Cystectomy, complete, with ureteroileal conduit or sigmoid bladder,
including bowel anastomosis
Cystectomy, complete, with ureteroileal conduit or sigmoid bladder,
51595 including bowel anastomosis: with bilateral pelvic lymphadenectomy, 240 ‫يساهم الصندوق‬
including external iliac, hypogastric and obturator nodes
Cystectomy, complete, with continent diversion, any technique, using any
segment of small and/or large bowel to construct neobladder
51600 Injection procedure for cystography or voiding urethrocystography 10 ‫يساهم الصندوق‬
Injection procedure and replacement of chain for contrast and/or chain
urethrocystography
51610 Injection procedure for retrograde urethrocystography 10 ‫يساهم الصندوق‬
51700 Bladder irrigation, simple, lavage and/or irrigation (separate procedure) 5 ‫يساهم الصندوق‬
51705 Change of cystostomy tube (separate procedure) 10 ‫يساهم الصندوق‬
51720 Bladder instillation of anticarcinogenic agent (including detention time) 15 ‫يساهم الصندوق‬
51725 Simple cystometrogram (CMG) (eg, spinal manometer) 10 ‫يساهم الصندوق‬
51726 Complex cystometrogram (eg, calibrated electronic equipment) 15 ‫يساهم الصندوق‬
Simple uroflowmetry (UFR) (eg. stop-watch flow rate, mechanical
uroflowmeter)
51739 Sound recording of external stream (eg, Lyons or Keitzer type) 5 ‫يساهم الصندوق‬
51741 Complex uroflowmetry (eg, calibrated electronic equipment) 10 ‫يساهم الصندوق‬
Urethral pressure profile studies (UPP) (urethral closure pressure profile),
any technique
Electromyography studies (EMG) of anal or urethral sphincter, any
technique
Stimulus evoked response (eg, measurement of bulbocavernous reflex
latency time)
51795 Voiding pressure studies (VP): bladder voiding pressure, any technique 10 ‫يساهم الصندوق‬
Voiding pressure studies (VP): intra-abdominal voiding pressure (AP)
(rectal, gastric, intra-peritoneal)
Cystoplasty or cystourethroplasty, plastic operation on bladder and/or
51800 vesical neck (anterior Y-plasty, vesical fundus resection), any procedure, 110 ‫يساهم الصندوق‬
with or without resection of posterior vesical neck
51820 Cystourethroplasty with unilateral or bilateral ureteroneocystostomy 120 ‫يساهم الصندوق‬
Anterior vesicourethropexy, or urethropexy (Marshall-Marchetti-Krantz
type)
Abdomino-vaginal vesical neck suspension, with or without endoscopic
control (eg, Stamey, Raz, modified Pereyra)
51860 Cystorrhaphy, suture of bladder wound, injury or rupture 70 ‫يساهم الصندوق‬
51880 Closure of cystostomy (separate procedure) 40 ‫يساهم الصندوق‬
51900 Closure of vesicovaginal fistula 80 ‫يساهم الصندوق‬
51920 Closure of vesicouterine fistula 80 ‫يساهم الصندوق‬
51925 Closure of vesicoenteric fistula: with hysterectomy 100 ‫يساهم الصندوق‬
51940 Closure of bladder exstrophy 140 ‫يساهم الصندوق‬
51960 Enterocystoplasty, including bowel anastomosis 150 ‫يساهم الصندوق‬
51980 Cutaneous vesicostomy 70 ‫يساهم الصندوق‬
52000 Cystourethroscopy diagnostic or therapeutic 25 ‫يساهم الصندوق‬
52204 Cystourethroscopy, with biopsy (separate procedure) 25 ‫يساهم الصندوق‬
Cystourethroscopy, with fulguration (including cryosurgery or laser
52214 surgery) of trigone, bladder neck, prostatic fossa, urethra, or periurethral 25 ‫يساهم الصندوق‬
glands
52224 surgery) for treatment of MINOR (less than 0.5 cm) lesion(s) with or 25 ‫يساهم الصندوق‬
without biopsy
surgery) for resection of SMALL bladder tumor(s) (0.5 to 2.0 cm)
surgery) for resection of MEDIUM bladder tumor(s) (2.0 to 5.0 cm)
surgery) for resection of LARGE bladder tumor(s) (greater than 5.0 cm)
Cystourethroscopy, with insertion of radioactive substance, with or
without biopsy or fulguration
52260 Cystourethroscopy, with dilation of bladder for interstitial cystitis 25 ‫يساهم الصندوق‬
52270 Cystourethroscopy, with internal urethrotomy 30 ‫يساهم الصندوق‬
52276 Cystourethroscopy with direct vision internal urethrotomy 35 ‫يساهم الصندوق‬
52277 Cystourethroscopy, with resection of external sphincter (sphincterotomy) 40 ‫يساهم الصندوق‬
Cystourethroscopy, with calibration and/or dilation of urethral stricture or
52281 stenosis, with or without meatotomy and injection procedure for 25 ‫يساهم الصندوق‬
cystography, male or female
Cystourethroscopy, with steroid injection into stricture (separate
procedure)
Cystourethroscopy for treatment of the female urethral syndrome and
52285 fulguration of polyp(s) of urethra, bladder neck, and/or trigone (separate 25 ‫يساهم الصندوق‬
procedure)
Cystourethroscopy: with ureteral meatotomy, unilateral or bilateral
Cystourethroscopy: with resection or fulguration of ureterocele(s),
unilateral or bilateral (separate procedure)
Cystourethroscopy: with incision or resection of orifice of bladder
diverticulum, single or multiple (separate procedure)
Cystourethroscopy, with removal of foreign body, calculus, or ureteral
stent from urethra or bladder (separate procedure)
Litholapaxy: crushing or fragmentation of calculus by any means in
bladder and removal of fragments
Cystourethroscopy (including ureteral catheterization): removal or
52320 fragmentation of ureteral calculus, with or without manipulation (separate 40 ‫يساهم الصندوق‬
procedure)
Cystourethroscopy, with insertion of indwelling ureteral stent (eg,
Gibbons or double-J type) (separate procedure)
Cystourethroscopy, with insertion of ureteral guide wire through kidney
to establish a percutaneous nephrostomy, retrograde (separate procedure)
Cystourethroscopy, with ureteroscopy and/or pyeloscopy (includes
52335 dilation of the ureter and or pyeloureteral junction by any method) with 40 ‫يساهم الصندوق‬
or without lithotripsy or removal of calculus (separate procedure)
Cystourethroscopy, with ureteroscopy and/or pyeloscopy (includes
52339 dilation of the ureter and/or pyeloureteral junction by any method: with 60 ‫يساهم الصندوق‬
resection of tumor (separate procedure)
Cystourethroscopy, with incision, fulguration or resection of bladder
52340 neck, and/or posterior urethra (congenital valves, obstructive 60 ‫يساهم الصندوق‬
hypertrophic mucosal folds)
52450 Transurethral incision of prostate 45 ‫يساهم الصندوق‬
52500 Transurethral resection of bladder neck (separate procedure) 50 ‫يساهم الصندوق‬
52510 Transurethral balloon dilation of the prostatic urethra, any method 40 ‫يساهم الصندوق‬
Transurethral resection of prostate including complete vasectomy,
52601 meatotomy, cystourethroscopy, urethral calibration and/or dilation, and 100 ‫يساهم الصندوق‬
internal urethrotomy
Transurethral fulguration for postoperative bleeding occuring after the
usual follow-up time
52612 Transurethral resection of prostate 60 ‫يساهم الصندوق‬
52640 Transurethral resection: of post operative bladder neck contracture 40 ‫يساهم الصندوق‬
Transurethral cryosurgical removal of prostate (postoperative irrigations
and aspiration of sloughing tissue included)
52700 Transurethral drainage of prostatic abscess 40 ‫يساهم الصندوق‬
Urethrotomy or urethrostomy, external: pendulous urethra, (separate
procedure)
Urethrotomy or urethrostomy, external: perineal urethra, external
53020 Meatotomy, cutting of meatus (separate procedure), any age 10 ‫يساهم الصندوق‬
53040 Drainage of deep periurethral abscess 30 ‫يساهم الصندوق‬
53060 Drainage of Skene's gland abscess or cyst 15 ‫يساهم الصندوق‬
Drainage of perineal urinary extravasation: uncomplicated (separate
procedure)
53085 Drainage of perineal urinary extravasation: complicated 50 ‫يساهم الصندوق‬
53200 Biopsy of urethra 15 ‫يساهم الصندوق‬
53210 Urethrectomy, total, including cystostomy 90 ‫يساهم الصندوق‬
53220 Excision or fulguration of carcinoma of urethra 40 ‫يساهم الصندوق‬
53230 Excision of urethral diverticulum (separate procedure) 60 ‫يساهم الصندوق‬
53240 Marsupialization of urethral diverticulum 35 ‫يساهم الصندوق‬
53250 Excision of bulbourethral gland (Cowper's gland) 35 ‫يساهم الصندوق‬
53260 Excision or fulguration: urethral polyp(s), distal urethra 20 ‫يساهم الصندوق‬
53265 Excision or fulguration: urethral caruncle 20 ‫يساهم الصندوق‬
53270 Excision or fulguration: Skene's gland 20 ‫يساهم الصندوق‬
53275 Excision or fulguration: urethral prolapse 20 ‫يساهم الصندوق‬
Urethroplasty: first stage, for fistula, diverticulum, or stricture (eg,
Johannsen type)
Urethroplasty: second stage (formation of urethra), including urinary
diversion
53410 Urethroplasty: one-stage reconstruction of anterior urethra 100 ‫يساهم الصندوق‬
Urethroplasty: transpubic or perineal, one stage, for reconstruction or
repair of prostatic or membranous urethra
Urethroplasty, two-stage reconstruction or repair of prostatic or
membranous urethra: each stage
Operation for correction of male urinary incontinence, with or without
introduction of prosthesis
53442 Removal of perineal prosthesis introduced for continence 50 ‫يساهم الصندوق‬
Urethroplasty with tubularization of posterior urethra and/or lower
bladder for incontinence (eg, Tenago, Leadbetter procedure)
Operation for correction of urinary incontinence with placement of
53445 inflatable urethral or bladder neck sphincter, including placement of 90 ‫يساهم الصندوق‬
pump and/or reservoir
Removal, repair or replacement of inflatable sphincter including pump
and/or reservoir and/or cuff
53449 Surgical correction of hydraulic abnormality of inflatable sphincter device 35 ‫يساهم الصندوق‬
53450 Urethromeatoplasty, with mucosal advancement 35 ‫يساهم الصندوق‬
Urethromeatoplasty, with partial excision of distal urethral segment
(Richardson type procedure)
53500 Suture of urethral wound or injury 35 ‫يساهم الصندوق‬
53510 Suture of urethral wound or injury: perineal 50 ‫يساهم الصندوق‬
53515 Suture of urethral wound or injury: prostatomembranous 80 ‫يساهم الصندوق‬
53520 Closure of urethrostomy or urethrocutaneous fistula 50 ‫يساهم الصندوق‬
53600 Dilation of urethral stricture by passage of sound or urethral dilator 10 ‫يساهم الصندوق‬
Dilation of urethral stricture or vesical neck by passage of sound or
urethral dilator
53620 Dilation of urethral stricture by passage of filiform and follower 10 ‫يساهم الصندوق‬
53640 Passage of filiform and follower for acute vesical retention 10 ‫يساهم الصندوق‬
53670 Catheterization, urethra 5 ‫يساهم الصندوق‬
54000 Slitting of prepuce, dorsal or lateral (separate procedure) 15 ‫يساهم الصندوق‬
54015 Incision and drainage of penis, deep 15 ‫يساهم الصندوق‬
Destruction of lesion(s), penis (eg, condyloma, papilloma, molluscum
contagiosum): any method
54100 Biopsy penis: (separate procedure) 15 ‫يساهم الصندوق‬
54110 Excision of penile plaque (Peyronie disease) 50 ‫يساهم الصندوق‬
54111 Excision of penile plaque: with graft 60 ‫يساهم الصندوق‬
54115 Removal foreign body from deep penile tissue (eg, plastic implant) 50 ‫ال يساهم الصندوق‬
54120 Amputation of penis: partial 50 ‫يساهم الصندوق‬
54130 Amputation of penis, radical: with bilateral lymphadenectomy 120 ‫يساهم الصندوق‬
54150 Circumcision, using clamp or other device: newborn 10 ‫يساهم الصندوق‬
54152 Circumcision, using clamp or other device: except newborn 15 ‫يساهم الصندوق‬
Circumcision, surgical excision other than clamp, device, or dorsal slit:
newborn
Circumcision, surgical excision other than clamp, device, or dorsal slit:
except newborn
54162 Revision of circumcision in operating room 30 ‫يساهم الصندوق‬
54200 Injection procedure for Peyronie disease 15 ‫يساهم الصندوق‬
54205 Injection procedure for Peyronie disease: with surgical exposure of plaque 50 ‫يساهم الصندوق‬
54220 Irrigation of corpora cavernosa for priapism 15 ‫يساهم الصندوق‬
54230 Injection procedure for corpora cavernosography 15 ‫يساهم الصندوق‬
Injection of corpora cavernosa with pharmacologic agent(s) (eg,
papaverine, phentolamine)
54240 Penile plethysmography 15 ‫يساهم الصندوق‬
54250 Nocturnal penile tumescence and/or rigidity test 15 ‫ال يساهم الصندوق‬
Plastic operation on penis for correction of chordee or for hypospadias
repair with or without transplantation of prepuce and/or skin
Urethroplasty for second stage hypospadias repair (including urinary
diversion) with free skin graft obtained from site other than genitalia
Urethroplasty for third stage hypospadias repair to release penis from
scrotum (eg, third stage Cecil repair)
One stage distal hypospadias repair (with or without chordee or
54322 circumcision): with simple meatal advancement (eg, Magpi, V-flap) or 80 ‫يساهم الصندوق‬
with urethroplasty by local skin flaps
One stage distal hypospadias repair (with or without chordee or
54326 circucision): with urethroplasty by local skin flaps and mobilization of 100 ‫يساهم الصندوق‬
urethra, or with correction of chordee with urethroplasty with skin graft
One stage proximal penile or penoscrotal hypospadias repair requiring
54332 extensive dissection to correct chordee and urethroplasty by use of skin 125 ‫يساهم الصندوق‬
graft tube and/or island flap
Repair of hypospadias complications (ie, fistula, stricture, diverticula): by
closure, incision, or excision, simple
Repair of hypospadias complications (ie. Fistula, stricture, diverticula):
54344 requiring mobilization of skin flaps and urethroplasty with flap or patch 85 ‫يساهم الصندوق‬
graft
Repair of hypospadias complications (ie, fistula, stricture, diverticula):
54348 requiring extensive dissection and urethroplasty with flap, patch or tubed 85 ‫يساهم الصندوق‬
graft (includes urinary diversion)
Repair of hypospadias cripple requiring extensive dissection and excision
54352 of previously constructed structures including re-release of chordee and 85 ‫يساهم الصندوق‬
reconstruction of urethra and penis
54360 Plastic operation on penis to correct angulation 50 ‫يساهم الصندوق‬
Plastic operation on penis for epispadias distal to external sphincter: with
or without incontinence
Plastic operation on penis for epispadias distal to external sphincter: with
exstrophy of bladder
54400 Insertion of penile prosthesis 50 ‫ال يساهم الصندوق‬
54402 Removal or replacement of penile prosthesis 50 ‫ال يساهم الصندوق‬
Insertion of inflatable (multi-component) penile prosthesis, including
placement of pump, cylinders, and/or reservoir
Removal, repair, or replacement of inflatable (multi-component) penile
prosthesis, including pump and/or reservoir and/or cylinders
Surgical correction of hydraulic abnormality of inflatable (multi-
component) prosthesis including pump and/or reservoir and/or cylinders
Corpora cavernosa-saphenous vein shunt (priapism operation), unilateral
or bilateral
Corpora cavernosa-corpus spongiosum shunt (priapism operation),
unilateral or bilateral
Corpora cavernosa-glans penis fistulization (eg, biopsy needle, Winter
procedure, rongeur, or punch) for priapism
54440 Plastic operation of penis for injury 50 ‫يساهم الصندوق‬
54500 Biopsy of testis: needle (separate procedure) 10 ‫يساهم الصندوق‬
54505 Biopsy of testis: incisional (separate procedure) 25 ‫يساهم الصندوق‬
54510 Excision of local lesion of testis 35 ‫يساهم الصندوق‬
Orchiectomy: simple (including subcapsular), with or without testicular
prosthesis, scrotal or inguinal approach
54530 Orchiectomy, radical, for tumor: any approach 60 ‫يساهم الصندوق‬
54560 Exploration for undescended testis with abdominal exploration 70 ‫يساهم الصندوق‬
Reduction of torsion of testis, surgical, with or without fixation of
contralateral testis
54620 Fixation of contralateral testis (separate procedure) 20 ‫يساهم الصندوق‬
54640 Orchiopexy, any type, with or without hernia repair 60 ‫يساهم الصندوق‬
54660 Insertion of testicular prosthesis (separate procedure) 20 ‫ال يساهم الصندوق‬
54670 Suture or repair of testicular injury 45 ‫يساهم الصندوق‬
54680 Transplantation of testis(es) to thigh (because of scrotal destruction) 60 ‫يساهم الصندوق‬
Incision and drainage of epididymis, testis, and/or scrotal space (eg,
abscess or hematoma)
54800 Biopsy of epididymis, needle 15 ‫يساهم الصندوق‬
54820 Exploration of epididymis, with or without biopsy 25 ‫يساهم الصندوق‬
54830 Excision of local lesion of epididymis 35 ‫يساهم الصندوق‬
54840 Excision of spermatocele, with or without epididymectomy 35 ‫يساهم الصندوق‬
54860 Epididymectomy: unilateral or bilateral 35 ‫يساهم الصندوق‬
Epididymovasostomy, anastomosis of epididymis to vas deferens:
Puncture aspiration of hydrocele, tunica vaginalis, with or without
injection of medication
55040 Excision of hydrocele: unilateral 35 ‫يساهم الصندوق‬
55060 Repair of tunica vaginalis hydrocele (Bottle type) 30 ‫يساهم الصندوق‬
55100 Drainage of scrotal wall abscess 10 ‫يساهم الصندوق‬
55110 Scrotal exploration 20 ‫يساهم الصندوق‬
55120 Removal of foreign body in scrotum 20 ‫يساهم الصندوق‬
55150 Resection of scrotum 30 ‫يساهم الصندوق‬
55175 Scrotoplasty 30 ‫يساهم الصندوق‬
Vasotomy, cannulization with or without incision of vas, unilateral or
bilateral (separate procedure)
55250 Vasectomy, unilateral or bilateral (separate procedure) 20 ‫يساهم الصندوق‬
Vasotomy for vasograms, seminal vesiculograms, or epididymograms,
55400 Vasovasostomy, vasovasorrhaphy 60 ‫يساهم الصندوق‬
Ligation (percutaneous) of vas deferens, unilateral or bilateral (separate
procedure)
55500 Excision of hydrocele of spermatic cord, unilateral (separate procedure) 35 ‫يساهم الصندوق‬
55520 Excision of lesion of spermatic cord (separate procedure) 40 ‫يساهم الصندوق‬
Excision of varicocele or ligation of spermatic veins for varicocele:
Excision of varicocele or ligation of spermatic veins for varicocele:
abdominal approach
55600 Vesiculotomy 45 ‫يساهم الصندوق‬
55650 Vesiculectomy, any approach 70 ‫يساهم الصندوق‬
55680 Excision of Mullerian duct cyst 40 ‫يساهم الصندوق‬
55700 Biopsy, prostate: needle or punch, single or multiple, any approach 15 ‫يساهم الصندوق‬
55705 Biopsy, prostate: incisional, any approach 30 ‫يساهم الصندوق‬
55720 Prostatotomy, external drainage of prostatic abscess, any approach 40 ‫يساهم الصندوق‬
55740 Prostatolithotomy, removal of prostatic calculus (separate procedure) 60 ‫يساهم الصندوق‬
Prostatectomy, perineal, subtotal (including control of postoperative
55801 bleeding, vasectomy, meatotomy, urethralcalibration and/or dilation, and 90 ‫يساهم الصندوق‬
internal urethrotomy)
55810 Prostatectomy, radical, with or without lymphadenectomy 150 ‫يساهم الصندوق‬
Prostatectomy (vasectomy, meatotomy, urethral calibration and/or
55821 dilation, and internal urethrotomy): suprapubic or retropubic, subtotal, 95 ‫يساهم الصندوق‬
one or two stages
55860 Exposure of prostate, any approah, for insertion of radiocative substance 70 ‫يساهم الصندوق‬
Exposure of prostate, any approach, for insertion of radioactive
substance: with limited pelvic lymphadenectomy
Exposure of prostate, any approach, for insertion of radioactive
55865 substance: with bilateral lymphadenectomy, including external iliac, 130 ‫يساهم الصندوق‬
hypogastric and obturator nodes
56300 Laparoscopy (peritoneoscopy), diagnostic (separate procedure) 30 ‫يساهم الصندوق‬
Laparoscopy (peritoneoscopy), surgical: with fulguration of oviducts
(with or without transection)
Laparoscopy (peritoneoscopy), surgical: with occlusion of oviducts by
device (eg, band, clip, or Falope ring)
Laparoscopy (peritoneoscopy), surgical: with fulguration or excision of
lesion of the ovary, pelvic viscera, or peritoneal surface by any method
56304 Laparoscopy (peritoneoscopy), surgical: with lysis of adhesions 45 ‫يساهم الصندوق‬
56305 Laparoscopy (peritoneoscopy), surgical: with biopsy (single or multiple) 35 ‫يساهم الصندوق‬
Laparoscopy (peritoneoscopy), surgical: with aspiration (single or
multiple)
Laparoscopy (peritoneoscopy), surgical: with removal of adnexal
structures (partial or total oophorectomy and/or salpingectomy)
Laparoscopy (peritoneoscopy), surgical: with vaginal hysterectomy with
56308 or without removal of tube(s), with or without removal of ovary(s) 80 ‫يساهم الصندوق‬
(laparoscopic assisted vaginal hysterectomy)
Laparoscopy (peritoneoscopy), surgical: with removal of leiomyomata,
subserosal (single or multiple)
Laparoscopy (peritoneoscopy), surgical: with retroperitoneal lymph node
biopsy(ies)
Laparoscopy (peritoneoscopy), surgical: with bilateral total pelvic
lymphadenectomy
Laparoscopy (peritoneoscopy), surgical: with bilateral total pelvic
lymphadenectomy and peri-aortic lymph node biopsy, single or multiple
56315 Laparoscopy (peritoneoscopy), surgical: appendectomy 60 ‫يساهم الصندوق‬
Laparoscopy (peritoneoscopy), surgical: repair of inguinal hernia, with or
without prosthesis
Laparoscopy (peritoneoscopy), surgical: with ligation of spermatic veins
for varicocele
56322 Laparoscopy (peritoneoscopy), surgical: transection of vagus nerves 100 ‫يساهم الصندوق‬
56324 Laparoscopy (peritoneoscopy), surgical: cholecystoenterostomy 75 ‫يساهم الصندوق‬
56340 Laparoscopy (peritoneoscopy), surgical: choelcystectomy (any method) 80 ‫يساهم الصندوق‬
Laparoscopy(peritoneoscopy), surgical: cholecystectomy with
cholangiography
Laparoscopy (peritoneoscopy), surgical: cholecystectomy with
exploration of common duct
56343 Laparoscopy (peritoneoscopy), surgical: with salpingostomy (unilateral) 80 ‫يساهم الصندوق‬
56344 Laparoscopy (peritoneoscopy), surgical: with fimbrioplasty (unilateral) 75 ‫يساهم الصندوق‬
56350 Hysteroscopy, diagnostic (separate procedure) 20 ‫يساهم الصندوق‬
Hysteroscopy, surgical: with biopsy of endometrium and/or polypectomy,
with or without D & C
56352 Hysteroscopy, surgical: with lysis of intrauterine adhesions (any method) 25 ‫يساهم الصندوق‬
Hysteroscopy, surgical: with division or resection of intrauterine septum
(any method)
56354 Hysteroscopy, surgical: with removal of leiomyomata 35 ‫يساهم الصندوق‬
56355 Hysteroscopy, surgical: with removal of impacted foreign body 25 ‫يساهم الصندوق‬
56356 Hysteroscopy, surgical: with endometrial ablation (any method) 35 ‫يساهم الصندوق‬
56405 Incision and drainage of vulva or perineal abscess 10 ‫يساهم الصندوق‬
56420 Incision and drainage of Bartholin's gland abscess 10 ‫يساهم الصندوق‬
56440 Marsupialization of Bartholin's gland cyst 25 ‫يساهم الصندوق‬
56441 Lysis of labial adhesions 15 ‫يساهم الصندوق‬
56501 Destruction of lesion(s) vulva (condylomata, multiple), any method 15 ‫يساهم الصندوق‬
56605 Biopsy of vulva or perineum (separate procedure) 10 ‫يساهم الصندوق‬
56620 Vulvectomy 55 ‫يساهم الصندوق‬
56631 Vulvectomy, radical, partial or complete: with lymphadenectomy 110 ‫يساهم الصندوق‬
56700 Partial hymenectomy or revision of hymenal ring 15 ‫يساهم الصندوق‬
56720 Hymenotomy, simple incision 5 ‫يساهم الصندوق‬
56740 Excision of Bartholin's gland or cyst 25 ‫يساهم الصندوق‬
56800 Plastic repair of introitus 30 ‫يساهم الصندوق‬
56805 Clitoroplasty for adrenogenital syndrome 100 ‫يساهم الصندوق‬
56810 Perineoplasty, repair of perineum, non-obstetrical (separate procedure) 35 ‫يساهم الصندوق‬
57000 Colpotomy: with exploration or drainage of pelvic abscess 20 ‫يساهم الصندوق‬
57065 Destruction of vaginal lesions, any method 20 ‫يساهم الصندوق‬
57100 Biopsy of vaginal mucosa: (separate procedure) 10 ‫يساهم الصندوق‬
57110 Vaginectomy, complete removal of vagina 45 ‫يساهم الصندوق‬
57120 Colpocleisis (Lefort type) 45 ‫يساهم الصندوق‬
57130 Excision of vaginal septum 20 ‫يساهم الصندوق‬
57135 Excision of vaginal cyst or tumor 20 ‫يساهم الصندوق‬
57200 Colporrhaphy: suture of injury of vagina (non obstetrical) 30 ‫يساهم الصندوق‬
Colpoperineorrhaphy: suture of injury of vagina and/or perineum (non
obstetrical)
Plastic operation on urethral sphincter, vaginal approach (eg, Kelly
urethral plication) (separate procedure)
57230 Plastic repair of urethrocele (separate procedure) 35 ‫يساهم الصندوق‬
Anterior colporrhaphy, repair of cystocele with or without repair of
urethrocele (separate procedure)
Posterior colporrhaphy, repair of rectocele with or without
perineorrhaphy (separate procedure)
Combined anteroposterior colporrhaphy: with or without enterocele
repair (separate procedure)
57270 Repair of enterocele, abdominal or vaginal approach (separate procedure) 50 ‫يساهم الصندوق‬
57280 Colpopexy, abdominal approach 55 ‫يساهم الصندوق‬
Sacrospinous ligament fixation for prolapse of vagina following
hysterectomy (separate procedure)
Sling operation for stress incontinence (eg, fascia or synthetic) (separate
procedure)
57289 Pereyra procedure, including anterior colporrhaphy (separate procedure) 70 ‫يساهم الصندوق‬
57292 Construction of artificial vagina: with or without graft 85 ‫يساهم الصندوق‬
57300 Closure of rectovaginal fistula: vaginal or transanal approach 50 ‫يساهم الصندوق‬
Closure of rectovaginal fistula: abdominal approach with or without
cocomitant colostomy
57310 Closure of urethrovaginal fistula: any method 50 ‫يساهم الصندوق‬
57330 Closure of vesicovaginal fistula: transvesical and vaginal approach 65 ‫يساهم الصندوق‬
57400 Dilation of vagina under anesthesia (separate procedure) 15 ‫يساهم الصندوق‬
57410 Pelvic examination under anesthesia (separate procedure) 15 ‫يساهم الصندوق‬
57452 Colposcopy (vaginoscopy): (separate procedure) 10 ‫يساهم الصندوق‬
57454 Colposcopy: with biopsies, or biopsy of the cervix (separate procedure) 10 ‫يساهم الصندوق‬
Colposcopy: with loop electrosurgical excision(s) of the cervix (LEEP)
Cervix, biopsy, single or multiple, or local excision of lesion, with or
without fulguration (separate procedure)
Endocervical curettage (not done as part of a dilation and curettage)
Cauterization of cervix: electro, thermal, cryo, or laser ablation (separate
procedure)
Conization of cervix, with or without fulguration, with or without dilation
and curettage, with or without repair (any method)
57530 Trachelectomy (cervicectomy), amputation of cervix (separate procedure) 35 ‫يساهم الصندوق‬
Excision of cervical stump, abdominal approach: with or without pelvic
floor repair
57550 Excision of cervical stump, vaginal approach 35 ‫يساهم الصندوق‬
Excision of cervical stump, vaginal approach: with anterior and/or
posterior repair, with or without repair of enterocele
57700 Cerclage of uterine cervix, non obstetrical 25 ‫يساهم الصندوق‬
57720 Trachelorrhaphy, plastic repair of uterine cervix, vaginal approach 25 ‫يساهم الصندوق‬
57820 Dilation and curettage of cervical stump (separate procedure) 15 ‫يساهم الصندوق‬
Endometrial and/or endocervical sampling (biopsy) without cevical
dilation, any method (separate procedure)
Dilation and curettage, diagnostic and/or therapaeutic (non obstetrical)
58140 Myomectomy, single or multiple (separate procedure): any approach 65 ‫يساهم الصندوق‬
Total abdominal hysterectomy (corpus and cervix), with or without
removal of tube(s), with or without removal of ovary(ies)
Total abdominal hysterectomy (corpus and cervix), with or without
58152 removal of tube(s), with or without removal of ovary(ies): with colpo- 95 ‫يساهم الصندوق‬
urethrocystopexy
Supracervical abdominal hysterectomy (subtotal hysterectomy), with or
without removal of tube(s), with or without removal of ovary(ies)
Total abdominal hysterectomy, including partial vaginectomy, with para-
58200 aortic and pelvic lymph node sampling, with or without removal of 130 ‫يساهم الصندوق‬
tube(s), with or without removal of ovary(ies)
Pelvic exenteration for gynecologic malignancy (total abdominal
58240 hysterectomy, removal of bladder, ureteral transplantations and/or 210 ‫يساهم الصندوق‬
abdominoperineal resection of rectum and colon and colostomy
Vaginal hysterectomy: with or without removal of tube(s) and/or
ovary(ies)
Vaginal hysterectomy: with colpo-urethrocystopexy (Marshall-Marchetti-
Krantz or Pereyra type, with/without endoscopic control)
Vaginal hysterectomy, with or without removal of tube(s), with or
without removal of ovary(ies): with repair of enterocele
58275 Vaginal hysterectomy, with total or partial colpectomy 110 ‫يساهم الصندوق‬
58300 Insertion of intrauterine device (IUD) 5 ‫ال يساهم الصندوق‬
58301 Removal of intrauterine device (IUD) 5 ‫ال يساهم الصندوق‬
58321 Artificial insemination: Intra-cervical or intra-uterine 10 ‫ال يساهم الصندوق‬
58340 Injection procedure for hysterosalpingography 5 ‫يساهم الصندوق‬
Transcervical introduction of fallopian tube catheter for diagnosis and/or
58345 re-establishing patency (any method), with or without 30 ‫يساهم الصندوق‬
hysterosalpingography
58350 Hydrotubation of oviduct 5 ‫يساهم الصندوق‬
Uterine suspension, with or without shortening of round and/or
sacrouterine ligaments (separate procedure)
58520 Hysterorrhaphy, repair or ruptured uterus (non obstetrical) 55 ‫يساهم الصندوق‬
58540 Hysteroplasty, repair of uterine anomaly (Strassman type) 70 ‫يساهم الصندوق‬
Ligation or transection of fallopian tube(s), abdominal or vaginal
approach, unilateral or bilateral
Ligation or transection of fallopian tube(s), abdominal or vaginal
58605 approach, postpartum, unilateral or bilateral, during same hospitalization 30 ‫يساهم الصندوق‬
Occlusion of fallopian tube(s) by device (eg, band, clip, Falope ring)
vaginal or suprapubic approach
Salpingectomy, complete or partial, unilateral or bilateral (separate
procedure)
Salpingo-oophorectomy, complete or partial, unilateral or bilateral
58740 Lysis of adhesions (salpingolysis, ovariolysis) (separate procedure) 40 ‫يساهم الصندوق‬
58750 Tubotubal anastomosis, microsurgical, unilateral 70 ‫يساهم الصندوق‬
58752 Tubouterine implantation, microsurgical, unilateral 60 ‫يساهم الصندوق‬
58760 Fimbrioplasty, microsurgical, unilateral 55 ‫يساهم الصندوق‬
58770 Salpingostomy (salpingoneostomy), microsurgical, unilateral 50 ‫يساهم الصندوق‬
58800 Drainage of ovarian cyst(s), unilateral or bilateral: vaginal approach 25 ‫يساهم الصندوق‬
58805 Drainage of ovarian cyst(s), unilateral or bilateral: abdominal approach 40 ‫يساهم الصندوق‬
58820 Drainage of ovarian abscess: vaginal approach 30 ‫يساهم الصندوق‬
58822 Drainage of ovarian abscess: abdominal approach 45 ‫يساهم الصندوق‬
58825 Transposition, ovary(s) 40 ‫يساهم الصندوق‬
58900 Biopsy of ovary, unilateral or bilateral 45 ‫يساهم الصندوق‬
58920 Wedge resection or bisection of ovary, unilateral or bilateral 50 ‫يساهم الصندوق‬
58940 Oophorectomy, partial or total, unilateral or bilateral 60 ‫يساهم الصندوق‬
Oophorectomy, unilateral or bilateral: for ovarian malignancy, with or
without para-aortic and pelvic lymph node biopsies, peritoneal
washings/biopsies, diaphragmatic assessments, salpingectomy(s),
omentectomy
Resection of ovarian malignancy with bilateral salpingo-oophorectomy
58951 and omentectomy: with total abdominal hysterectomy, pelvic and limited 120 ‫يساهم الصندوق‬
para-aortic lymphadenctomy
Resection of ovarian malignancy with bilateral salpingo-oophorectomy
and omentectomy: with radical dissection for debulking
58960 Laparatomy, for staging or restaging of ovarian malignancy 65 ‫يساهم الصندوق‬
58970 Follicle puncture for oocyte retrieval, any method 30 ‫ال يساهم الصندوق‬
58974 Embryo transfer, any method (separate procedure) 20 ‫ال يساهم الصندوق‬
58976 Gamete or zygote intrafallopian transfer, any method 40 ‫ال يساهم الصندوق‬
59000 Amniocentesis, any method 10 ‫يساهم الصندوق‬
59012 Cordocentesis (intrauterine), any method 25 ‫يساهم الصندوق‬
59015 Chorionic villus sampling, any method 20 ‫يساهم الصندوق‬
59020 Fetal contraction stress test (separate procedure) 5 ‫يساهم الصندوق‬
59025 Fetal non-stress test (separate procedure) 5 ‫يساهم الصندوق‬
59030 Fetal scalp blood sampling (separate procedure) 10 ‫يساهم الصندوق‬
Initiation and/or supervision of internal fetal monitoring during labor by
consultant with report
59100 Hysteretomy, abdominal (eg, for removal of hydatiform mole, abortion) 60 ‫يساهم الصندوق‬
Surgical treatment of ectopic pregnancy: tubal or ovarian, requiring
salpingectomy and/or oophorectomy, abdominal or vaginal approach
Surgical treatment of ectopic pregnancy: tubal or ovarian, without
salpingectomy and/or oophorectomy
59130 Surgical treatment of ectopic pregnancy: abdominal pregnancy 60 ‫يساهم الصندوق‬
59140 Surgical treatment of ectopic pregnancy: cervical, with evacuation 35 ‫يساهم الصندوق‬
Laparoscopic treatment of ectopic pregnancy: with or without
salpingectomy and/or oophorectomy
59160 Curettage, postpartum (separate procedure) 25 ‫يساهم الصندوق‬
59200 Insertion of cervical dilator (eg.laminaria) (separate procedure) 5 ‫يساهم الصندوق‬
59300 Episiotomy or vaginal repair only, by other than attending physician 15 ‫يساهم الصندوق‬
59320 Cerclage of cervix, during pregnancy: vaginal 20 ‫يساهم الصندوق‬
59325 Cerclage of cervix , during pregnancy: abdominal 40 ‫يساهم الصندوق‬
59350 Hysterorrhaphy of ruptured uterus 45 ‫يساهم الصندوق‬
Vaginal delivery only (with or without episiotomy and/or forceps)
including postpartum care
59414 Manual removal of retained placenta by consultant 30 ‫يساهم الصندوق‬
Cesarean delivery including postpartum care, with or without
hysterectomy
Treatment of incomplete or missed abortion, any trimester, completed
surgically
59830 Treatment of septic abortion, completed surgically 35 ‫يساهم الصندوق‬
59840 Induced abortion, by dilation and curettage 20 ‫يساهم الصندوق‬
59841 Induced abortion, by dilation and evacuation 30 ‫يساهم الصندوق‬
Induced abortion, by one or more intra-amniotic injections
(amniocentesis-injections), including delivery of fetus and secundines
59851 (amniocentesis-injections), including delivery of fetus and secundines: 40 ‫يساهم الصندوق‬
with dilation and curettage and/or evacuation
59852 (amniocentesis-injections), including delivery of fetus and secundines: 55 ‫يساهم الصندوق‬
with hysterotomy (failed intra-amniotic injection)
59870 Uterine evacuation and curettage for hydatiform mole 35 ‫يساهم الصندوق‬
60000 Incision and drainage of thyroglossal cyst, infected 15 ‫يساهم الصندوق‬
60100 Biopsy, thyroid, percutaneous needle 15 ‫يساهم الصندوق‬
60200 Excision of cyst or adenoma of thyroid, or transection of isthmus 55 ‫يساهم الصندوق‬
60210 Partial thyroid lobectomy, unilateral: with or without isthmusectomy 60 ‫يساهم الصندوق‬
60220 Total thyroid lobectomy, unilateral (hemithyroidectomy) 90 ‫يساهم الصندوق‬
Total thyroid lobectomy, unilateral: with contralateral subtotal
lobectomy, including isthmus
60240 Thyroidectomy, total or complete 120 ‫يساهم الصندوق‬
Thyroidectomy, total or subtotal for malignancy: with limited neck
dissection
Thyroidectomy, total or subtotal for malignancy: with radical neck
dissection
Thyroidectomy, including substernal thyroid gland, sternal split or
transthoracic approach
60271 Thyroidectomy, including substernal thyroid gland: cervical approach 100 ‫يساهم الصندوق‬
60280 Excision of thyroglossal duct cyst or sinus 50 ‫يساهم الصندوق‬
60500 Parathyroidectomy 105 ‫يساهم الصندوق‬
Parathyroidectomy, with mediastinal exploration, sternal split or
transthoracic approach
60520 Thymectomy, partial or total (separate procedure) 100 ‫يساهم الصندوق‬
Adrenalectomy, partial or complete, or exploration of adrenal gland with
or without biopsy, transabdominal, lumbar or dorsal (separate procedure)
Adrenalectomy, partial or complete, with excision of adjacent
retroperitoneal tumor, unilateral
60600 Excision of carotid body tumor: without excision of carotid artery 110 ‫يساهم الصندوق‬
60605 Excision of carotid body tumor: with excision of carotid artery 130 ‫يساهم الصندوق‬
Subdural tap through fontanelle or suture, infant, unilateral or bilateral:
each session
Ventricular puncture through previous burr hole, fontanelle, suture or
61026 implanted ventricular catheter/reservoir: with or without injection of drug 15 ‫يساهم الصندوق‬
or other substance for diagnosis or treatment
Cisternal or lateral cervical (C1-C2) puncture: without injection (separate
procedure)
61105 Twist drill hole for subdural or ventricular puncture (separate procedure) 45 ‫يساهم الصندوق‬
Twist drill hole for subdural or ventricular puncture: for implanting
ventricular catheter or pressure recording device (separate procedure)
Twist drill hole for subdural or ventricular puncture: for evacuation
and/or drainage of subdural hematoma (separate procedure)
Burr hole(s) or trephine: with biopsy of brain or intracranial lesion
Burr hole(s) or trephine: with drainage of brain abscess or cyst (separate
procedure)
Burr hole(s) with evacuation and/or drainage of hematoma, extradural or
subdural (separate procedure)
Burr hole(s): with aspiration of hematoma or cyst, intracerebral (separate
procedure)
Burr hole(s): for implanting ventricular catheter, reservoir, EEG
electrode(s), or pressure recording device (separate procedure)
Insertion of subcutaneous reservoir, pump or continuous infusion system
for connection to ventricular catheter (separate procedure)
61304 Craniectomy or craniotomy, exploratory, supratentorial 130 ‫يساهم الصندوق‬
61305 Craniectomy or craniotomy, exploratory, infratentorial (posterior fossa) 160 ‫يساهم الصندوق‬
Craniectomy or craniotomy for evacuation of hematoma or drainage of
intracranial abscess (separate procedure)
61330 Decompression of orbit only, transcranial approach 155 ‫يساهم الصندوق‬
Exploration of orbit (transcranial approach): with biopsy, removal of
lesion or foreign body
Craniectomy, suboccipital with cervical laminectomy for decompression
61343 of medulla and spinal cord, with or without dural graft (eg, Arnold-Chiari 190 ‫يساهم الصندوق‬
malformation)
61345 Other cranial decompression, posterior fossa 175 ‫يساهم الصندوق‬
Craniectomy, subtemporal, for section, compression or decompression of
sensory root of gasserian ganglion
Craniectomy, suboccipital: for exploration or decompression of cranial
nerves
Craniectomy, suboccipital: for mesencephalic tractotomy or
61480 pedunculotomy, section of one or more cranial nerves or for medullary 160 ‫يساهم الصندوق‬
tractotomy
61490 Craniectomy for lobotomy, including cingulotomy 165 ‫يساهم الصندوق‬
61500 Craniectomy: with excision of tumor or other bone lesion of skull 130 ‫يساهم الصندوق‬
61501 Craniectomy: for osteomyelitis 110 ‫يساهم الصندوق‬
Craniectomy, trephination, bone flap craniotomy: for excision of brain
tumor or abscess or fenestration of syst, supratentorial
Craniectomy for excision of brain tumor, infratentorial or posterior fossa:
cerebellopontine angle tumor, or midline tumor at base of skull
cerbellopontine angle tumor
midline tumor at base of skull
Craniectomy, infratentorial or posterior fossa: for excision or fenestration
of cyst or brain abscess
Craniectomy, bone flap craniotomy, transtemporal (mastoid) for excision
61530 of cerebellopontine angle tumor: combined with or without 265 ‫يساهم الصندوق‬
middle/posterior fossa craniotomy/craniectomy
Craniotomy, with elevation of bone flap for subdural implantation of an
electrode array: for long term seizure monitoring
Craniotomy, trephination, bone flap craniotomy: for excision of
epileptogenic focus without electrocorticography during surgery
Craniotomy, trephination, bone flap craniotomy: for removal of epidural
61535 or subdural electrode array, without excision of cerebral tissue (separate 70 ‫يساهم الصندوق‬
procedure)
Craniotomy, trephination, bone flap craniotomy: for excision of cerebral
61536 epileptogenic focus, with electrocorticography during surgery (includes 195 ‫يساهم الصندوق‬
removal of electrode array)
Craniotomy, trephination, bone flap craniotomy: for lobectomy with
electrocorticography during surgery, partial or total
Craniotomy, trephination, bone flap craniotomy: for transection of corpus
callosum
Craniotomy, trephination, bone flap craniotomy: for total
hemispherectomy
Craniotomy, trephination, bone flap craniotomy: for partial or subtotal
hemispherectomy
Craniotomy, trephination, bone flap craniotomy: for excision of
craniopharyngioma
Craniotomy for hypophysectomy or excision of pituitary tumor,
intracranial approach
Hypophysectomy or excision of pitutary tumor, transnasal or transseptal
approach, non-stereotactic
Craniectomy for craniostenosis: single or multiple sutures, or frontal or
partial bone flap, or bifrontal bone flap
Extensive craniectomy for multiple cranial suture craniosynostosis (eg,
cloverleaf skull): with or without grafts
Excision, intra- and extracranial, benign tumor of cranial bone (eg,
fibrous dysplasia): with or without optic nerve decompression
Craniectomy or craniotomy: with treatment of penetrating wound of brain
with or without removal of foreign from brain
Transoral approach to skull base, brain stem or upper spinal cord for
61576 biopsy, decompression or excision of lesion: with or without splitting of 245 ‫يساهم الصندوق‬
tongue and/or mandible (including tracheostomy)
Transcatheter occlusion or embolization (eg, for tumor destruction, to
61624 achieve hemostoasis, to occlude a vascular malformation), percutaneous, 135 ‫يساهم الصندوق‬
any method: central nervous system (intracranial, cord)
Surgery of intracranial arteriovenous malformation: infratentorial or dural
,supratentorial
Surgery of intracranial aneurysm, intracranial approach: vertebral-basilar
circulation or carotid circulation
Surgery of intracranial aneurysm, cervical approach by application of
occluding clamp to cervical carotid artery (Selverstone- Crutchfield type)
61705 Surgery of aneurysm, vascular malformation or carotid-cavernous fistula 215 ‫يساهم الصندوق‬
Surgery of aneurysm, vascular malformation or carotid-cavernous fistula:
by intra-arterial embolization, injection procedure, or balloon catheter
Anastomosis, arterial, extracranial-intracranial (eg, middle
cerebral/cortical) arteries
Microdissection, intracranial or spinal procedure (list separately in
addition to code for primary procedure)
Creation of lesion by stereotactic method, including burr hole(s) and
61720 localizing and recording techniques, single or multiple stages: globus 105 ‫يساهم الصندوق‬
pallidus or thalamus
Creation of lesion by stereotactic method, including burr hole(s) and
61735 localizing and recording techniques, single or multiple stages: subcortical 130 ‫يساهم الصندوق‬
structures other than globus pallidus or thalamus
Stereotactic biopsy, aspiration, or excision, including burr hole(s), for
intracranial lesion
Stereotactic biopsy, aspiration, or excision, including burr hole(s), for
intracranial lesion: with computerized tomography
Stereotactic localization, any method, including burr hole(s): with
insertion of catheter(s) for brachytherapy
Creation of lesion by stereotactic method, percutaneous, by neurolytic
agent (eg, alcohol, thermal, electrical, radiofrequency): gasserian ganglion
Twist drill or burr hole(s) for implantation of neurostimulator electrodes:
cortical or subcortical
Craniectomy or craniotomy for implantation of neurostimulator
electrodes, cerebral
Twist drill, burr hole, craniotomy or craniectomy for steriotactic
implantation of one neurostimulator array in in subcortical site (eg.
thalamus, globus pallidus,subthalamic nucleus, periventricular
periacqueductal gray)
Incision and subcutaneous placement of cranial neurostimulator pulse
generator or receiver, direct or inductive coupling
Revision or removal of cranial neurostimulator electrodes or pulse
generator or receiver
62000 Elevation of depressed skull fracture: simple, extradural 80 ‫يساهم الصندوق‬
Elevation of depressed skull fracture: compound or comminuted,
extradural with or without repair of dura and/or debridment of brain
Craniotomy for repair of dural/CSF leak, including surgery for
rhinorrhea/otorrhea
Reduction of craniomegalic skull (eg, treated hydrocephalus): not
requiring bone grafts or cranioplasty
Reduction of craniomegalic skull (eg, treated hydrocephalus): with
cranioplasty (prosthetic material)
Reduction of craniomegalic skull (eg, treated hydrocephalus): requiring
62117 craniotomy and reconstruction with or without bone autograft (includes 160 ‫يساهم الصندوق‬
obtaining grafts)
62120 Repair of encephalocele, skull vault, including cranioplasty 155 ‫يساهم الصندوق‬
62121 Craniotomy with repair of encephalocele, skull base 140 ‫يساهم الصندوق‬
62142 Removal of bone flap or prosthetic plate of skull 70 ‫يساهم الصندوق‬
62143 Replacement of bone flap or prosthetic plate of skull 100 ‫يساهم الصندوق‬
62145 Cranioplasty for skull defect with or without reparative brain surgery 125 ‫يساهم الصندوق‬
62146 Cranioplasty with autograft (includes obtaining bone grafts) 135 ‫يساهم الصندوق‬
62180 Ventriculocisternostomy (Torkildsen type operation) 85 ‫يساهم الصندوق‬
62190 Creation of shunt: subarachnoid/subdural-atrial, -jugular, -auricular 80 ‫يساهم الصندوق‬
Creation of shunt: subarachnoid / subdural-peritoneal, subdural-pleural,
other terminus
62194 Replacement or irrigation, subarachnoid/subdural catheter 35 ‫يساهم الصندوق‬
Ventriculocisternostomy, third ventricle: stereotactic method or any
method
62220 Creation of shunt: ventriculo-atrial, -jugular, -auricular 100 ‫يساهم الصندوق‬
62223 Creation of shunt: ventriculo-peritoneal, -pleural, other terminus 110 ‫يساهم الصندوق‬
62225 Replacement or irrigation, ventricular catheter 35 ‫يساهم الصندوق‬
Replacement or revision of CSF shunt, obstructed valve, or distal catheter
in shunt system
62256 Removal of complete CSF shunt system: without replacement 40 ‫يساهم الصندوق‬
Removal of complete CSF shunt system: with replacement by similar or
other shunt at same operation
62268 Percutaneous aspiration, spinal cord cyst or syrinx 30 ‫يساهم الصندوق‬
62269 Biopsy of spinal cord, percutaneous needle 30 ‫يساهم الصندوق‬
62270 Spinal puncture, diagnostic 10 ‫يساهم الصندوق‬
62273 Injection, lumbar epidural, of blood or clot patch 15 ‫يساهم الصندوق‬
Injection of anesthetic or other substance, diagnostic or therapeutic:
epidural, subarachnoid, or subdural, single
Injection of anesthetic or other substance, diagnostic or therapeutic:
epidural, subarachnoid, or subdural, continuous
Injection of neurolytic substance (eg, alcohol, phenol, iced saline
solution): subarachnoid, caudal, or epidural
Injection procedure for myelography and/or computerized axial
tomography, spinal (other than C1-C2 and posterior fossa)
Aspiration procedure, percutaneous, of nucleus pulposus of intervertebral
disk, any method, single or multiple levels
Injection of substance other than anesthetic, contrast or neurolytic
solutions: any site (separate procedure)
62290 Injection procedure for diskography, each level: any site 15 ‫يساهم الصندوق‬
Injection procedure for chemonucleolysis, including diskography,
intervertebral disk, single or multiple levels, lumbar
Injection procedure, arterial, for occlusion of arteriovenous malformation,
spinal
Implantation, revision or repositioning of tunneled intrathecal or epidural
62350 catheter, for long term medication administration via an external pump or 45 ‫يساهم الصندوق‬
implantable reservoir/infusion pump
Implantation or replacement of device for intrathecal or epidural drug
infusion, subcutaneous reservoir
Laminectomy with exploration and/or decompression of spinal cord
63001 and/or cauda equina, without facetectomy, foraminotomy or diskectomy, 110 ‫يساهم الصندوق‬
one or two vertebral segments: cervical, thoracic, lumbar or sacral
Laminectomy with removal of abnormal facets and/or pars inter-
63012 articularis with decompression of cauda equina and nerve roots for 110 ‫يساهم الصندوق‬
spondylolisthesis, lumbar (Gill type procedure)
Laminectomy with exploration and/or decompression of spinal cord
63015 and/or cauda equina, without facetectomy, foraminotomy or diskectomy, 130 ‫يساهم الصندوق‬
more than 2 vertebral segments: cervical, thoracic or lumbar
Laminotomy with decompression of nerve root(s), including partial
63020 facetectomy, foraminotomy and/or excision of herniated intervertebral 100 ‫يساهم الصندوق‬
disk: one interspace, cervical or lumbar
Laminotomy with decompression of nerve root(s), including partial
disk: each additional interspace, cervical or lumbar
Laminotomy, with decompression of nerve root(s), including partial
disk, re-exploration: cervical or lumbar
Laminectomy, facetectomy and foraminotomy (unilateral or bilateral)
63045 with decompression of spinal cord, cauda equina and/or nerve root(s), 120 ‫يساهم الصندوق‬
single vertebral segment: cervical
63046 with decompression of spinal cord, cauda equina and/or nerve root(s), 110 ‫يساهم الصندوق‬
single vertebral segment: thoracic or lumbar
63048 with decompression of spinal cord, cauda equina and/or nerve root(s): 30 ‫يساهم الصندوق‬
each additional segment, cervical, thoracic or lumbar
Transpedicular approach with decompression of spinal cord, cauda
equina and/or nerve roots, single segment: thoracic or lumbar
Transpedicular approach with decompression of spinal cord, cauda
equina and/or nerve root(s): each additional segment, thoracic or lumbar
Costovertebral approach with decompression of spinal cord or nerve
root(s), thoracic: single segment
Costovertebral approach with decompression of spinal cord or nerve
root(s), thoracic: each additional segment
Diskectomy, anterior, with decompression of spinal cord and/or nerve
root(s), including osteophytectomy: cervical or thoracic , single
Diskectomy, anterior, with decompression of spinal cord and/or nerve
63076 root(s), including osteophytectomy: cervical or thoracic, each additional 30 ‫يساهم الصندوق‬
interspace
Vertebral corpectomy, partial or complete, anterior approach or trans-
63081 thoracic approach, with decompression of spinal cord and/or nerve 145 ‫يساهم الصندوق‬
root(s): cervical or thoracic, single segment
Vertebral corpectomy, partial or complete, anterior approach with
63082 decompression of spinal cord and/or nerve root(s): cevical or thoracic, 30 ‫يساهم الصندوق‬
each additional segment
Vertebral corpectomy, partial or complete, combined thoracolumbar
63087 approach with decompression of spinal cord and/or nerve root(s), lower 175 ‫يساهم الصندوق‬
thoracic or lumbar: single segment
Vertebral corpectomy, partial or complete, combined thoracolumbar
63088 approach with decompression of spinal cord and/or nerve root(s), lower 30 ‫يساهم الصندوق‬
thoracic or lumbar: each additional segment
Vertebral corpectomy, transperitoneal or retroperitoneal approach with
63090 decompression of spinal cord, cauda equina and/or nerve root(s), lower 170 ‫يساهم الصندوق‬
thoracic, lumbar, or sacral: single segment
Vertebral corpectomy, transperitoneal or retroperitoneal approach with
63091 decompression of spinal cord, cauda equina and/or nerve root(s), lower 30 ‫يساهم الصندوق‬
thoracic, lumbar, or sacral: each additional segment
Laminectomy with myelotomy (eg, Bischof or Drez type), cervical,
thoracic or thoracolumbar
Laminectomy with drainage of intramedullary cyst/syrinx: to
subarachnoid space or to peritonial space
Laminectomy and section of dentate ligaments, with or without dural
graft, cervical: one or more segments
63185 Laminectomy with rhizotomy: one or more segments 105 ‫يساهم الصندوق‬
63191 Laminectomy with section of spinal accessory nerve 120 ‫يساهم الصندوق‬
Laminectomy with cordotomy, with section of one spinothalamic tract,
one stage: cervical
Laminectomy with cordotomy, with section of both spinothalamic tracts,
one stage: cervical or thoracic
Laminectomy with cordotomy, with section of both spinothalamic tracts,
two stages within fourteen days: cervical
63200 Laminectomy, with release of tethered spinal cord, lumbar 130 ‫يساهم الصندوق‬
Laminectomy for excision or occlusion of arteriovenous malformation of
spinal cord: cervical or thoracic
Laminectomy for excision or occlusion of arteriovenous malformation of
spinal cord: thoracolumbar
Laminectomy for excision of intraspinal lesion other than neoplasm,
external or intradural: any site
Laminectomy for biopsy and/or excision of intraspinal neoplasm:
extradural, any site
Laminectomy for biopsy/excision of intraspinal neoplasm: intradural,
extramedullary, any site
Laminectomy for biopsy/excision of intraspinal neoplasm: intradural,
intramedullary, any level
Laminectomy for biopsy/excision of intraspinal neoplasm: combined
extradural-intradural lesion, any level
Vertebral corpectomy, partial or complete, for excision of intraspinal
lesion, single segment: extradural or intradural, any level
Vertebral corpectomy, partial or complete, for excision of intraspinal
lesion: each additional segment
Creation of lesion of spinal cord by stereotactic method, percutaneous,
any modality (including stimulation and/or recording)
Stereotactic stimulation of spinal cord, percutaneous, separate procedure
not followed by other surgery
63615 Stereotactic biopsy, aspiration, or excision of lesion, spinal cord 115 ‫يساهم الصندوق‬
63650 Percutaneous implantation of neurostimulator electrodes: epidural 45 ‫يساهم الصندوق‬
Laminectomy for implantation of neurostimulator electrodes: epidural or
subdural
63660 Revision or removal of neurostimulator electrodes 40 ‫يساهم الصندوق‬
Incision and subcutaneous placement of spinal neurostimulator pulse
Revision or removal of implanted spinal neurostimulator pulse generator
or receiver
Electronic analysis of implanted neuromuscular pulse generator system:
with or without reprogramming of pulse generator
63700 Repair of meningocele or myelomeningocele 140 ‫يساهم الصندوق‬
63709 Repair of dural/CSF leak or pseudomeningocele, with laminectomy 100 ‫يساهم الصندوق‬
63710 Dura graft, spinal 100 ‫يساهم الصندوق‬
Creation of shunt, lumbar, subarachnoid-peritoneal, -pleural, or other:
including laminectomy or percutaneous, not requiring laminectomy
63744 Replacement, irrigation or revision of lumbosubarachnoid shunt 50 ‫يساهم الصندوق‬
63746 Removal of entire lumbosubarachnoid shunt system without replacement 40 ‫يساهم الصندوق‬
Injection, anesthetic agent: somatic nerve, any division or branch, single
level
Injection, anesthetic agent: somatic nerve, any division or branch, each
additional level
64413 Injection nerve plexus, somatic 15 ‫يساهم الصندوق‬
Injection, anesthetic agent, sphenopalatine ganglion, carotid sinus, or
stellate ganglion)
64520 Injection, lumbar or thoracic (paravertebral sympathetic) 20 ‫يساهم الصندوق‬
64530 Injection, c£liac plexus, with or without radiologic monitoring 25 ‫يساهم الصندوق‬
64553 Percutaneous implantation of neurostimulator electrodes: any site 15 ‫يساهم الصندوق‬
64573 Incision for implantation of neurostimulator electrodes: any site 30 ‫يساهم الصندوق‬
64585 Revision or removal of peripheral neurostimulator electrodes 20 ‫يساهم الصندوق‬
Incision and subcutaneous placement of pripheral neurostimulator pulse
Revision or removal of peripheral neurostimulator pulse generator or
receiver
Destruction by neurolytic agent (eg, chemical, thermal, electrical, or
radiofrequency) of somatic nerve, per level
64612 Destruction by neurolytic agent under radiologic monitoring, per level 25 ‫يساهم الصندوق‬
64702 Neuorplasty: digital, one or both, same digit 30 ‫يساهم الصندوق‬
64704 Neuroplasty: nerve of hand or foot 30 ‫يساهم الصندوق‬
64708 Neuroplasty, major peripheral nerve, arm or leg: other than specified 45 ‫يساهم الصندوق‬
64712 Neuroplasty: sciatic nerve 55 ‫يساهم الصندوق‬
64713 Neuroplasty: brachial plexus 90 ‫يساهم الصندوق‬
64714 Neuroplasty: lumbar plexus 75 ‫يساهم الصندوق‬
64716 Neuroplasty and/or transposition: any major nerve 40 ‫يساهم الصندوق‬
64722 Decompression of nerve 35 ‫يساهم الصندوق‬
Internal neurolysis requiring use of operating microscope (list separately
64727 in addition to code for neuroplasty) (neuroplasty includes external 30 ‫يساهم الصندوق‬
neurolysis)
64732 Transection or avulsion of nerve: any site other than vagus 40 ‫يساهم الصندوق‬
Transection or avulsion of nerve: vagus (vagotomy), transthoracic or
abdominal
Transection or avulsion of nerve: vagi limited to proximal stomach
64755 (selective proximal vagotomy, proximal gastric vagotomy, parietal cell 95 ‫يساهم الصندوق‬
vagotomy, supra- or highly selective vagotomy)
64774 Excision of neuroma: cutaneous nerve, any site, hand or foot 40 ‫يساهم الصندوق‬
64784 Excision of neuroma: major peripheral nerve, except sciatic 65 ‫يساهم الصندوق‬
64786 Excision of neuroma: sciatic nerve 110 ‫يساهم الصندوق‬
Implantation of nerve end into bone or muscle (list separately in addition
to neuroma excision)
64788 Excision of neurofibroma or neurolemmoma: cutaneous nerve 35 ‫يساهم الصندوق‬
64790 Excision of neurofibroma or neurolemmoma: major peripheral nerve 75 ‫يساهم الصندوق‬
64795 Biopsy of nerve 15 ‫يساهم الصندوق‬
64802 Sympathectomy: cervical, thoracolumbar or lumbar 65 ‫يساهم الصندوق‬
64804 Sympathectomy: cervicothoracic 100 ‫يساهم الصندوق‬
Microdissection and/or microrepair of nerve (list separately in addition to
code for nerve repair)
64831 Suture of nerve: hand or foot, each nerve 60 ‫يساهم الصندوق‬
64856 Suture of major peripheral nerve, arm or leg: including transposition 95 ‫يساهم الصندوق‬
64857 Suture of major peripheral nerve, arm or leg: without transposition 95 ‫يساهم الصندوق‬
64859 Suture of each additional major peripheral nerve 30 ‫يساهم الصندوق‬
64861 Suture of brachial or lumbar plexus 135 ‫يساهم الصندوق‬
64864 Suture of nerve: facial, extracranial 85 ‫يساهم الصندوق‬
64865 Suture of nerve: facial, intratemporal, with or without grafting 110 ‫يساهم الصندوق‬
64866 Anastomosis: facial-spinal accessory, facial-hypogossal or facial-phrenic 110 ‫يساهم الصندوق‬
Suture of nerve: requiring secondary or delayed suture (list separately in
addition to code for primary nerve suture)
Suture of nerve: requiring extensive mobilization, or transposition of
nerve (list separately in addition to code for nerve suture)
Suture of nerve: requiring shortening of bone of extremity (list separately
in addition to code for nerve suture)
64885 Nerve graft (includes obtaining graft), head or neck 120 ‫يساهم الصندوق‬
Nerve graft (includes obtaining graft), single or multiple strand, hand,
foot, arm or leg
64901 Nerve graft, each additional nerve: single or multiple strand 75 ‫يساهم الصندوق‬
64905 Nerve pedicle transfer: first stage 80 ‫يساهم الصندوق‬
64907 Nerve pedicle transfer: second stage 100 ‫يساهم الصندوق‬
65091 Evisceration of ocular contents: with or without implant 45 ‫يساهم الصندوق‬
Enucleation of eye: with or without implant, with or without attachment
of muscles
Exenteration of orbit: with or without skin graft, therapeutic removal of
bone, muscle or myocutaneous flap
Reinsertion of ocular implant, with or without conjunctival graft or use of
65150 foreign material for reinforcement and/or attachment of muscles to 50 ‫ال يساهم الصندوق‬
implant
65175 Removal of ocular implant 40 ‫ال يساهم الصندوق‬
Removal of foreign body, external eye: including concretions,
conjunctival, subconjunctival, or scleral nonperforating
65222 Removal of foreign body, external eye: corneal, with slit lamp 10 ‫يساهم الصندوق‬
65235 Removal of foreign body, intraocular: from anterior chamber or lens 55 ‫يساهم الصندوق‬
Removal of foreign body, intraocular: from posterior segment, magnetic
extraction
Removal of foreign body, intraocular: from posterior segment,
nonmagnetic extraction
Repair of laceration: conjunctiva, with or without nonperforating
laceration sclera, direct closure
Repair of laceration: cornea, nonperforating, with or without removal of
foreign body
Repair of laceration: cornea and/or sclera, perforating, not involving
uveal tissue
Repair of laceration: cornea and/or sclera, perforating, with reposition or
resection of uveal tissue
65286 Repair of laceration: application of tissue glue, wounds of sclera/cornea 40 ‫يساهم الصندوق‬
65290 Repair of wound, extraocular muscle, tendon and/or Tenon's capsule 35 ‫يساهم الصندوق‬
65291 Exploration of eye under general anesthesia 15 ‫يساهم الصندوق‬
65292 Removal of sutures under general anesthesia (child) 15 ‫يساهم الصندوق‬
65400 Keratectomy: lamellar, partial (except pterygium) 40 ‫يساهم الصندوق‬
65410 Biopsy of cornea 10 ‫يساهم الصندوق‬
65420 Excision or transposition of pterygium: without graft 30 ‫يساهم الصندوق‬
65426 Excision or transposition of pterygium: with graft 35 ‫يساهم الصندوق‬
65430 Scraping of cornea, diagnostic, for smear and/or culture 10 ‫يساهم الصندوق‬
Removal of corneal epithelium: with or without chemocauterization
(abrasion, curettage)
Removal of corneal epithelium: with application of chelating agent (such
as EDTA)
Destruction of lesion of cornea by cryotherapy, photocoagulation or
thermo-cauterization
65600 Tattoo of cornea, mechanical or chemical 30 ‫ال يساهم الصندوق‬
65710 Keratoplasty: lamellar 80 ‫يساهم الصندوق‬
65730 Keratoplasty: penetrating 95 ‫يساهم الصندوق‬
65770 Keratoprosthesis 115 ‫يساهم الصندوق‬
65771 Radial keratotomy 85 ‫ال يساهم الصندوق‬
Corneal relaxing incision or wedge resection for correction of surgically
induced astigmatism
Paracentesis of anterior chamber of eye (separate procedure): with
diagnostic aspiration of aqueous
65820 Goniotomy 50 ‫يساهم الصندوق‬
65850 Trabeculotomy ab externo 70 ‫يساهم الصندوق‬
Trabeculoplasty by laser surgery, one or more sessions (defined treatment
series)
Severing adhesions of anterior segment, laser technique (separate
procedure)
Severing adhesions of anterior segment of eye, incisional technique (with
65880 or without injection of air or liquid) (separate procedure): corneo-vitreal 50 ‫يساهم الصندوق‬
adhesions
65900 Removal of epithelial downgrowth, anterior chamber of eye 60 ‫يساهم الصندوق‬
65920 Removal of implanted material, anterior segment of eye 55 ‫يساهم الصندوق‬
65930 Removal of blood clot, anterior segment of eye 50 ‫يساهم الصندوق‬
66130 Excision of lesion, sclera 50 ‫يساهم الصندوق‬
Fistulization of sclera for glaucoma: with iridectomy, any technique
Fistulization of sclera for glaucoma: trabeculectomy ab externo (separate
procedure)
Aqueous shunt to extraocular reservoir, (eg, Molteno, Schocket, or
Denver-Krupin)
66185 Revision of aqueous shunt to extraocular reservoir 55 ‫يساهم الصندوق‬
66220 Repair of scleral staphyloma: without graft 50 ‫يساهم الصندوق‬
66225 Repair of scleral staphyloma: with graft 75 ‫يساهم الصندوق‬
Revision or repair of operative wound of anterior segment, any type, early
or late, major or minor procedure
Iridectomy, with corneoscleral or corneal section: for removal of lesion,
and/or with cyclectomy
Iridectomy, with corneoscleral or corneal section: peripheral or sector, for
glaucoma (separate procedure)
Iridectomy, with corneoscleral or corneal section:optical (seperate
procedure)
66680 Repair of iris, ciliary body (as for iridodialysis) 45 ‫يساهم الصندوق‬
Suture of iris, ciliary body (separate procedure) with retrieval of suture
through small incision (eg, McCannel suture)
Ciliary boby destruction: diathermy, cyclophotocoagulation, cryotherapy
or cyclodialysis
66761 Iridotomy/iridectomy by laser surgery (eg, for glaucoma) 25 ‫يساهم الصندوق‬
Iridoplasty by photocoagulation (eg, for improvement of vision, for
widening of anterior chamber angle)
66770 Destruction of cyst or lesion iris or ciliary body (nonexcisional procedure) 35 ‫يساهم الصندوق‬
Discission, secondary membranous cataract (opacified posterior lens
capsule and/or anterior hyaloid): stab incision technique
Discission of secondary membranous cataract (opacified posterior lens
capsule and/or anterior hyaloid): laser surgery (one or more stages)
Repositioning of intraocular lens prosthesis, requiring an incision
Removal of secondary membranous cataract with corneo-scleral section,
with or without iridectomy (iridocapsulotomy, iridocapsulectomy)
66840 Removal of lens material: aspiration technique, one or more stages 55 ‫يساهم الصندوق‬
Removal of lens material: phacofragmentation technique (mechanical or
ultrasonic), with aspiration
66852 Removal of lens material: pars plana approach, with or without vitrectomy 65 ‫يساهم الصندوق‬
66920 Removal of lens material: extra- or intracapsular 65 ‫يساهم الصندوق‬
Extra- or intracapsular cataract removal with insertion of intraocular lens
prosthesis (one stage procedure), manual or mechanical technique
Insertion of intraocular lens prosthesis (secondary implant), not
66985 associated with concurrent cataract removal, with or without anterior 70 ‫يساهم الصندوق‬
vitrectomy
66986 Exchange of intraocular lens 80 ‫يساهم الصندوق‬
Removal of vitreous, anterior approach (open sky technique or limbal
incision): partial, or subtotal removal with mechanical vitrectomy
Aspiration or release of vitreous, subretinal or choroid fluid, pars plana
approach (posterior sclerotomy)
Injection of vitreous substitute, pars plana or limbal approach, (fluid-gas
exchange), with or without aspiration (separate procedure)
67028 Intravitreal injection of pharmacologic agent (separate procedure) 20 ‫يساهم الصندوق‬
67030 Discission of vitreous strands (without removal), pars plana approach 30 ‫يساهم الصندوق‬
Severing of vitreous strands, vitreous face adhesions, sheets, membranes
or opacities, laser surgery (one or more stages)
Vitrectomy, mechanical, pars plana approach: with or without epiretinal
membrane stripping, or focal or panretinal endolaser photocoagulation
Vitrectomy, mechanical, pars plana approach: with endolaser panretinal
photocoagulation
Repair of retinal detachment, one or more sessions: cryotherapy,
67105 diathermy, or photocoagulation (laser or xenon arc), with or without 50 ‫يساهم الصندوق‬
drainage of subretinal fluid
Repair of retinal detachment: scleral buckling (such as lamellar excision,
imbrication or encircling procedure), with or without implant
Repair of retinal detachment: with vitrectomy, any method, with or
without air or gas tamponade, focal endolaser photocoagulation,
cryotherapy, drainage of subretinal fluid, scleral buckling, and/or removal
of lens by same technique
Repair of retinal detachment, one or more sessions: by injection of air or
other gas (eg, pneumoretinopexy)
67112 Repair of retinal detachment: previously operated upon, any technique 125 ‫يساهم الصندوق‬
67115 Release of encircling material (posterior segment) 40 ‫يساهم الصندوق‬
67120 Removal of implanted material, posterior segment: extraocular 40 ‫يساهم الصندوق‬
67121 Removal of implanted material, posterior segment: intraocular 70 ‫يساهم الصندوق‬
Prophylaxis of retinal detachment (eg, retinal break, lattice degeneration)
67145 without drainage, one or more sessions, photocoagulation (laser or xenon 40 ‫يساهم الصندوق‬
arc), cryotherapy, or diathermy
Destruction of localized lesion of retina (eg, maculopathy, choroidopathy,
67208 small tumors), one or more sessions: cryotherapy, diathermy or 65 ‫يساهم الصندوق‬
photocoagulation (laser or xenon arc)
Destruction of localized lesion of retina: radiation by implantation of
source (includes removal of source)
Destruction of extensive or progressive retinopathy (eg, diabetic
67227 retinopathy), one or more sessions: cryotheapy, diathermy, or 55 ‫يساهم الصندوق‬
photocoagulation (laser or xenon arc)
67311 Strabismus surgery: any technique, any number of muscles 60 ‫يساهم الصندوق‬
Placement of adjustable suture(s) during strabismus surgery, including
67335 postoperative adjustment(s) (report in addition to specific strabismus 20 ‫يساهم الصندوق‬
surgery)
67345 Chemodenervation of extraocular muscle 20 ‫يساهم الصندوق‬
67350 Biopsy of extraocular muscle 20 ‫يساهم الصندوق‬
Orbitotomy without bone flap (frontal or transconjunctival approach): for
67400 exploration, with or without biopsy, drainage, removal of lesion or 60 ‫يساهم الصندوق‬
foreign body, or removal of bone for decompression
67415 Fine needle aspiration of orbital contents 10 ‫يساهم الصندوق‬
Orbitotomy with bone flap or window, lateral approach: with removal of
67420 lesion, foreign body, drainage, bone for decompression or exploration, 90 ‫يساهم الصندوق‬
with or without biopsy
Retrobulbar injection: medication, alcohol (separate procedure, does not
include supply of medication)
67515 Injection of therapeutic agent into Tenon's capsule 10 ‫يساهم الصندوق‬
Optic nerve decompression (eg, incision or fenestration of optic nerve
sheath)
67700 Blepharotomy, drainage of abscess, eyelid 10 ‫يساهم الصندوق‬
67710 Severing of tarsorrhaphy 10 ‫يساهم الصندوق‬
67715 Canthotomy (separate procedure) 10 ‫يساهم الصندوق‬
67800 Excision of chalazion(s), single or multiple, same or different lids 30 ‫يساهم الصندوق‬
67810 Biopsy of eyelid 10 ‫يساهم الصندوق‬
Correction of trichiasis: incision of lid margin, with or without free
mucous membrane graft
Excision of lesion of eyelid (except chalazion) without closure or with
simple direct closure
67850 Destruction of lesion of lid margin (up to 1 cm) 15 ‫يساهم الصندوق‬
67875 Temporary closure of eyelids by suture (eg, Frost suture) 10 ‫يساهم الصندوق‬
Construction of intermarginal adhesions, median tarsorrhaphy, or
canthorrhaphy: without transposition of tarsal plate
Construction of intermarginal adhesions, median tarsorrhaphy, or
canthorrhaphy: with transposition of tarsal plate
67900 Repair of brow ptosis (supraciliary, mid-forehead or coronal approach) 40 ‫يساهم الصندوق‬
Repair of blepharoptosis: frontalis muscle technique with suture, other
material or fascial sling (includes obtaining fascia)
Blepharoptosis repair: (tarso)levator resection or advancement, internal or
external approach
Blepharoptosis repair: conjunctivo-tarso-Muller's muscle-levator
resection (eg, Fasanella-Servat type)
67909 Reduction of overcorrection of ptosis 35 ‫يساهم الصندوق‬
67911 Correction of lid retraction 35 ‫يساهم الصندوق‬
67914 Repair of ectropion: suture or thermocauterization 25 ‫يساهم الصندوق‬
Repair of ectropion: blepharoplasty, excision tarsal wedge or extensive
(eg, Kuhnt-Szymanowski or tarsal strip operations)
67921 Repair of entropion: suture or thermocauterization 20 ‫يساهم الصندوق‬
Repair of entropion: blepharoplasty, excision tarsal wedge or extensive
(eg, Wheeler operation)
Suture of recent wound, eyelid,involving lid margin, tarsus, and/or
palpebral conjunctiva: partial or full thickness
67938 Removal of embedded foreign body, eyelid 10 ‫يساهم الصندوق‬
67950 Canthoplasty (reconstruction of canthus) 50 ‫يساهم الصندوق‬
Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva,
67961 canthus, or full thickness, may include preparation for skin graft or 45 ‫يساهم الصندوق‬
pedicle flap with adjacent tissue transfer or rearrangement
Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival
flap from opposing eyelid: first stage
Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival
flap from opposing eyelid: second stage
68020 Incision of conjunctiva, drainage of cyst(s) 10 ‫يساهم الصندوق‬
68100 Biopsy of conjunctiva 10 ‫يساهم الصندوق‬
68110 Excision of lesion, conjunctiva 15 ‫يساهم الصندوق‬
68130 Excision of lesion, conjunctiva: with adjacent sclera 35 ‫يساهم الصندوق‬
68200 Subconjunctival injection 5 ‫يساهم الصندوق‬
Conjunctivoplasty, with or without reconstruction cul-de-sac: with
68326 conjunctival graft, extensive rearrangement, or buccal mucous membrane 50 ‫يساهم الصندوق‬
graft (includes obtaining graft)
68330 Repair of symblepharon: conjunctivoplasty, without graft 30 ‫يساهم الصندوق‬
Repair of symblepharon: with free graft conjunctiva or buccal mucous
membrane (includes obtaining graft)
Repair of symblepharon: division of symblepharon with or without
insertion of conformer or contact lens
68360 Conjunctival flap: bridge or partial 30 ‫يساهم الصندوق‬
68362 Conjunctival flap: total (eg, Gunderson thin flap or purse string flap) 50 ‫يساهم الصندوق‬
68400 Snip incision of lacrimal punctum 10 ‫يساهم الصندوق‬
68510 Biopsy of lacrimal gland 30 ‫يساهم الصندوق‬
68525 Biopsy or excision of lacrimal sac 50 ‫يساهم الصندوق‬
68540 Excision of lacrimal gland tumor: frontal approach without osteotomy 65 ‫يساهم الصندوق‬
68550 Excision of lacrimal gland tumor: frontal approach with osteotomy 85 ‫يساهم الصندوق‬
68700 Plastic repair of lacrimal canaliculi 45 ‫يساهم الصندوق‬
68705 Correction of everted punctum, cautery 15 ‫يساهم الصندوق‬
68720 Dacryocystorhinostomy (fistulization of lacrimal sac to nasal cavity) 55 ‫يساهم الصندوق‬
Conjunctivorhinostomy (fistulization of conjunctiva to nasal cavity): with
or without insertion of tube or stent
Closure of lacrimal punctum by thermocauterization, ligation, or laser
surgery
68801 Dilation of lacrimal punctum, with or without irragation, one or both eyes 10 ‫يساهم الصندوق‬
68810 Probing of nasolacrimal duct, with or without irrigation, one or both eyes 10 ‫يساهم الصندوق‬
68815 Probing of nasolacrimal duct with implantation of tube or stent, one eye 20 ‫يساهم الصندوق‬
68840 Probing of lacrimal canaliculi, with or without irrigation 10 ‫يساهم الصندوق‬
68850 Injection of contrast medium for dacryocystography 10 ‫يساهم الصندوق‬
69000 Drainage external ear, abscess or hematoma (separate procedure) 10 ‫يساهم الصندوق‬
69100 Biopsy external ear or auditory canal (separate procedure) 10 ‫يساهم الصندوق‬
69110 Excision external ear: partial, simple repair or complete amputation 20 ‫يساهم الصندوق‬
69140 Excision exostosis(es), external auditory canal 50 ‫يساهم الصندوق‬
Radical excision external auditory canal lesion: with or without neck
dissection
69200 Removal foreign body from external auditory canal (separate procedure) 5 ‫يساهم الصندوق‬
69210 Removal impacted cerumen (separate procedure), one or both ears 5 ‫يساهم الصندوق‬
69220 Debridement, mastoidectomy cavity 10 ‫يساهم الصندوق‬
69300 Otoplasty, protruding ear, with or without size reduction 50 ‫ال يساهم الصندوق‬
Reconstruction of external auditory canal (meatoplasty) (eg, for stenosis
due to trauma, infection), (separate procedure)
69320 Reconstruction external auditory canal for congenital atresia, single stage 110 ‫يساهم الصندوق‬
Myringotomy including aspiration and/or eustachian tube inflation
69424 Ventilating tube removal when originally inserted by another physician 10 ‫يساهم الصندوق‬
69433 Tympanostomy (requiring insertion of ventilating tube) 20 ‫يساهم الصندوق‬
Middle ear exploration through postauricular or ear canal incision
69501 Mastoidectomy: simple 75 ‫يساهم الصندوق‬
69511 Mastoidectomy: radical, any procedure 90 ‫يساهم الصندوق‬
69530 Petrous apicectomy including radical mastoidectomy 120 ‫يساهم الصندوق‬
69535 Resection temporal bone, external approach 210 ‫يساهم الصندوق‬
69540 Excision aural polyp (separate procedure) 20 ‫يساهم الصندوق‬
Revision mastoidectomy: resulting in radical mastoidectomy or
apicectomy
69604 Revision mastoidectomy: resulting in tympanoplasty or mastoidectomy 90 ‫يساهم الصندوق‬
69620 Myringoplasty, uncomplicated 60 ‫يساهم الصندوق‬
Tympanoplasty without mastoidectomy (including canalplasty,
atticotomy and/or middle ear surgery), initial or revision: any method
Tympanoplasty with antrotomy or mastoidectomy (including canalplasty,
69635 atticotomy, middle ear surgery, and/or tympanic membrane repair): with 110 ‫يساهم الصندوق‬
or without ossicular chain reconstruction, any method
Stapedectomy or stapedotomy with reestablishment of ossicular
continuity, with or without use of foreign material
Stapedectomy or stapedotomy with reestablishment of ossicular
continuity, with or without use of foreign material: with footplate drill out
69666 Repair oval window fistula (separate procedure) 75 ‫يساهم الصندوق‬
69667 Repair round window fistula (separate procedure) 75 ‫يساهم الصندوق‬
69670 Mastoid obliteration (separate procedure) 75 ‫يساهم الصندوق‬
69676 Tympanic neurectomy 75 ‫يساهم الصندوق‬
69700 Closure postauricular fistula, mastoid (separate procedure) 50 ‫يساهم الصندوق‬
69720 Decompression facial nerve, intratemporal 110 ‫يساهم الصندوق‬
69740 Suture facial nerve, intratemporal, with or without graft or decompression 110 ‫يساهم الصندوق‬
Labyrinthotomy, with or without cryosurgery or other nonexcisional
destructive procedures or tack procedure: transcanal
Labyrinthotomy, with or without cryosurgery or other nonexcisional
destructive procedures or tack procedure: with mastoidectomy
69805 Endolymphatic sac operation: with or without shunt 110 ‫يساهم الصندوق‬
69905 Labyrinthectomy: transcanal 75 ‫يساهم الصندوق‬
69910 Labyrinthectomy: with mastoidectomy 120 ‫يساهم الصندوق‬
69950 Vestibular nerve section, transcranial approach 155 ‫يساهم الصندوق‬
69955 Total facial nerve decompression and/or repair (may include graft) 160 ‫يساهم الصندوق‬
69960 Decompression internal auditory canal 160 ‫يساهم الصندوق‬
69970 Removal of tumor, temporal bone 180 ‫يساهم الصندوق‬
74283 Barium enema, therapeutic, for reduction of intussuception 25 ‫يساهم الصندوق‬
75989 Radiological guidance for percutanous drainage of fluid collection 20 ‫يساهم الصندوق‬
Localization of breast nodule or calcification before operations with
marker and confirmation of its position with appropriate imaging
Ophtalmic echography, diagnostic:A-scan only, with amplitude
quantification
76512 Ophtalmic echography, diagnostic:B-scan only 5 ‫يساهم الصندوق‬
Echography, breast(s) (unilateral or bilateral), B-scan and or real time
image documentation
Echography, abdominal (unilateral or bilateral), B-scan and or real time
image documentation: complete
Echography, abdominal (unilateral or bilateral), B-scan and or real time
image documentation: limited (e.g, single organ, quadrant, follow-up)
Echography, pregnant uterus (unilateral or bilateral), B-scan and or real
time image documentation: complete (fetal and maternal evaluation)
76818 Fetal biophysical profile 5 ‫يساهم الصندوق‬
Echocardiography, fetal, cardiovascular system, reral time with image
documentation (2D) with or without M-mode recording
Doppler echocardiography, fetal, cardiocascular system. pulsed wave
and/or continuous wave spectral display
Echography, pelvic (nonobstetruc), B-scan and/or real time with image
documentation complete
77761 Intracavitary radioelement application 30 ‫يساهم الصندوق‬
85095 Bone marrow :aspiration only 5 ‫يساهم الصندوق‬
85097 Bone marrow : smear interpretation only 5 ‫يساهم الصندوق‬
85102 Bone marrow biopsy: needle or trochar 5 ‫يساهم الصندوق‬
Fine needle aspiration with or without preparation of smears :
supperficial tissue (eg, thyroid, breast, prostate)
Fine needle aspiration with or without preparation of smears : deep tissue
under radiologic guidance
90802 Interactive medical psychiatric diagnostic interview examination 10 ‫يساهم الصندوق‬
90808 Narcosynthesis for psychiatric diagnostic and therapeutic purposes 9 ‫يساهم الصندوق‬
90810 Interactive individual medical psychotherapy 12 ‫ال يساهم الصندوق‬
Individual medical psychotherapy by a physician, with continuing
medical diagnostic evaluation, and drug management when indicated,
including insight oriented, behavior modifying or supportive
psychotherapy: 20 to 30 minutes
90845 Medical psychoanalysis 8 ‫ال يساهم الصندوق‬
90846 Family medical psychotherapy (without the paptient present) 10 ‫ال يساهم الصندوق‬
Family medical psychotherapy (conjoint psychotherapy) by a physician,
90847 with continuing medical diagnostic evaluation, and drug management as 12 ‫ال يساهم الصندوق‬
indicated
Multiple-family group medical psychotherapy by a physician, with
90849 continuig medical diagnostic evaluation, and drug management when 4 ‫ال يساهم الصندوق‬
indicated
Group medical psychotherapy (other than of a multiple-family group) by
90853 a physician, with continuing medical diagnostic evaluation and drug 4 ‫ال يساهم الصندوق‬
management when indicated
90857 Interactive group medical psychotherapy 4 ‫ال يساهم الصندوق‬
Pharmacologic management, including prescription, use and review of
medication with no more than minimal medical psychotherapy
Electroconvulsive therapy with or without monitoring, single or multiple
seizures, per day
Individual psychophysiological therapy incorporating biofeedback
training by any modality: up to 50 minutes
90880 Medical hypnotherapy 14 ‫ال يساهم الصندوق‬
90901 Biofeedback training by any modality 3 ‫ال يساهم الصندوق‬
90911 Biofeedback training, anorectal, including EMG and/or manometry 6 ‫ال يساهم الصندوق‬
90935 Dialysis procedure: acute, any mode, hospitalized patient, up to 3 sessions 30 ‫يساهم الصندوق‬
Dialysis procedure: chronic, any mode, with or without substantial
revision of dialysis prescription
Dialysis training, patient, including helper when applicable, any mode,
per course (excluding dialysis)
90997 Hemoperfusion (eg, with activated charcoal or resin) 30 ‫يساهم الصندوق‬
Esophageal intubation and collection of washings for cytology, including
preparation of specimens (separate procedure)
Esophageal motility study with or without stimulant (eg. mecholyl or
similar stimulant) or acid perfusion
91020 Esophagogastric manometric studies 15 ‫يساهم الصندوق‬
91030 Esophagus, acid perfusion (Bernstein) test for esophagitis 15 ‫يساهم الصندوق‬
Esophagus, acid reflux test, with intraluminal pH electrode for detection
of gastroesophageal reflux
Esophagus, acid reflux test, with intraluminal pH electrode for detection
of gastroesophageal reflux: prolonged recording (24 hours)
Gastric analysis test with injection of stimulant of gastric secretion (eg,
histamine, insulin, pentagastrin, calcium and secretin)
Gastric intubation, washings, and preparation of slides for cytology
91060 Gastric saline load test 5 ‫يساهم الصندوق‬
91065 Breath hydrogen test (eg, for detection of lactase deficiency) 5 ‫يساهم الصندوق‬
91100 Intestinal bleeding tube, passage, positioning and monitoring 8 ‫يساهم الصندوق‬
Gastric intubation and aspiration or lavage for treatment (eg, for ingested
poisons or drugs)
91122 Anorectal manometry 15 ‫يساهم الصندوق‬
91299 Echoendoscopy 40 ‫يتطلب موافقة‬
Eye examination: routine(external examination, visual acuity, PAM or
BAT, direct ophthalmoscopy, tonometry, gross visual fields, muscle
balance, slit lamp microscopy, color vision test (plates), with or without
refraction
Eye examination: comprehensive (external examination, visual acuity,
PAM or BAT, direct ophthalmoscopy, tonometry, gross visual fields,
muscle balance, slit lamp microscopy, color vision test plates, optic disc
assessment with three-mirror lens (with
Ophthalmological examination and evaluation under general anesthesia,
92018 with or without manipulation of globe for passive range of motion or 15 ‫يساهم الصندوق‬
other manipulation to facilitate diagnostic examination
92020 Gonioscopy with medical diagnostic evaluation (separate procedure) 2 ‫يساهم الصندوق‬
Sensorimotor examination with multiple measurements of ocular
92060 deviation and medical diagnostic evaluation (eg, restrictive or paretic 6 ‫يساهم الصندوق‬
muscle with diplopia) (separate procedure)
Orthoptic and/or pleoptic training, with continual medical direction and
evaluation (separate procedure)
Fitting of contact lens for treatment of disease, with medical supervision
and follow-up
Visual field examination, unilateral or bilateral, with medical diagnostic
92081 evaluation: limited (eg, tangent screen, Autoplot, arc perimeter, or single 6 ‫يساهم الصندوق‬
stimulus level automated test) (separate procedure)
Visual field examination, unilateral or bilateral, with medical diagnostic
92082 evaluation: intermediate (at least 2 isopters on Goldmann perimeter, or 6 ‫يساهم الصندوق‬
automated suprathreshold screening program) (separate procedure)
Visual field examination, unialteral or bilateral, with medical diagnostic
92083 evaluation: extended (eg, at least 3 isopters on Goldmann perimeter and 6 ‫يساهم الصندوق‬
static determination within the central 30 degrees) (separate procedure)
Serial tonometry (separate procedure) same day (eg, diurnal curve or
medical treatment of acute elevation of intraocular pressure)
Tonography with medical diagnostic evaluation, recording indentation
92120 tonometer method or perilimbal suction method, with or without water 6 ‫يساهم الصندوق‬
provocation (separate procedure)
Provocative tests for glaucoma, with medical diagnostic evaluation,
without tonography (separate procedure)
92150 Photocoagulation or laser first session 20 ‫يساهم الصندوق‬
92151 Photocoagulation or laser each supplemetn session max 3 10 ‫يساهم الصندوق‬
Ophthalmoscopy, extended as for retinal detachment (may include use of
92225 contact lens, drawing or sketch, and/or fundus biomicroscopy), with 6 ‫يساهم الصندوق‬
medical diagnostic evaluation (separate procedure)
Ophthalmoscopy, with medical diagnostic evaluation: with fluorescein
92235 angiography (includes multiframe photography), or with fundus 8 ‫يساهم الصندوق‬
photography
Oculoelectromyography, one or more extraocular muscles, one or both
eyes, with medical diagnostic evaluation (separate procedure)
Electro-oculography, with medical diagnostic evaluation (separate
procedure)
Electroretinography, with medical diagnostic evaluation (separate
procedure)
92280 Visually evoked potential study (response), with diagnostic evaluation 5 ‫يساهم الصندوق‬
Color vision examination, extended, eg, anomaloscope or equivalent
Dark adaptation examination, with medical diagnostic evaluation
External ocular photography with medical diagnostic evaluation for
92285 documentation of medical progress (eg, close-up photography, slit lamp 3 ‫يساهم الصندوق‬
photography, goniophotography, stereo-photography) (separate procedure)
Special anterior segment photography with medical diagnostic evaluation,
92286 with specular endothelial microscopy and cell count, with or without 6 ‫يساهم الصندوق‬
fluorescein angiography
92288 Pachymetry 6 ‫يساهم الصندوق‬
92289 Confocal microscopy 6 ‫يساهم الصندوق‬
92290 Corneal topography (mapping) 6 ‫يساهم الصندوق‬
Prescription of optical and physical characteristics of and fitting of
92310 contact lens(es), with medical supervision of adaptation: corneal or 10 ‫ال يساهم الصندوق‬
corneoscleral
Prescription of prosthesis and direction of fitting and supply by
independent technician, with medical supervision of adaptation
92502 Otolaryngologic examination under general anesthesia 15 ‫يساهم الصندوق‬
Medical evaluation of speech, language, and/or hearing problems
92511 Nasopharyngoscopy with endoscope (separate procedure) 5 ‫يساهم الصندوق‬
92512 Nasal function studies, eg, rhinomanometry (separate procedure) 5 ‫يساهم الصندوق‬
92516 Facial nerve function studies (separate procedure) 3 ‫يساهم الصندوق‬
92520 Laryngeal function studies 5 ‫يساهم الصندوق‬
Spontaneous nystagmus test (including gaze and fixation nystagmus)
with recording
92542 Positional nystagmus test, minimum of 4 positions, with recording 2 ‫يساهم الصندوق‬
Caloric vestibular test, each irrigation (binaural, bithermal stimulation
constitutes four tests), with recording
Optokinetic nystagmus test, bidirectional, foveal or peripheral
stimulation, with recording
92545 Oscillating tracking test, with recording 2 ‫يساهم الصندوق‬
92546 Torsion swing test, with recording 2 ‫يساهم الصندوق‬
Basic comprehensive audiometry (pure tone, air and bone, and speech
threshold and discrimination)
Special audiometry (tone decay test, short increment sensitivity test
(SISI), and pure tone (Stenger) test
Tympanometry (impedance testing) with or without acoustic reflex and/or
acoustic decay reflex test
92584 Electrocochleography 3 ‫يساهم الصندوق‬
92585 Brainstem evoked response recording (evoked response audiometry) 5 ‫يساهم الصندوق‬
92590 Hearing aid examination and selection, monaural or binaural 1 ‫ال يساهم الصندوق‬
92592 Hearing aid check, monaural or binaural 1 ‫ال يساهم الصندوق‬
92594 Electroacoustic evaluation for hearing aid, monaural or binaural 2 ‫ال يساهم الصندوق‬
92950 Cardiopulmonary resuscitation (eg, cardiac arrest) 25 ‫يساهم الصندوق‬
92953 Temporary transcutaneous pacing 3 ‫يساهم الصندوق‬
92960 Cardioversion, elective, electrical conversion of arrhythmia, external 15 ‫يساهم الصندوق‬
Thrombolysis, coronary: by intracoronary infusion, including selective
coronary angiography
92977 Thrombolysis, coronary: by intravenous infusion 30 ‫يساهم الصندوق‬
Intravascular ultrasound (coronary vessel or graft) during therapeutic
intervention including imaging supervision, interpretation and report
Transcatheter placement of an intracoronary stent(s), percutaneous, with
or without other therapeutic intervention, any method: single vessel
Transcatheter placement of an intracoronary stent(s), percutaneous, with
92981 or without other therapeutic intervention, any method: each additional 30 ‫يساهم الصندوق‬
vessel
92982 Percutaneous transluminal angioplasty: single vessel 85 ‫يتطلب موافقة‬
92984 Percutaneous transluminal angioplasty: each additional vessel 15 ‫يساهم الصندوق‬
92987 Percutaneous balloon valvuloplasty: mitral valve 150 ‫يتطلب موافقة‬
92990 Percutaneous balloon valvuloplasty: pulmonary valve 110 ‫يتطلب موافقة‬
Atrial septectomy or septostomy: transvenous method, balloon, Rashkind
type (includes cardiac catheterization)
Atrial septectomy or septostomy: blade method (Park septostomy)
(includes cardiac catheterization)
Percutaneous transluminal coronary atherectomy, by mechanical or other
method, with or without balloon angioplasty: single vessel
Percutaneous transluminal coronary atherectomy, by mechanical or other
method, with or without balloon angioplasty: each additional vessel
93010 ECG, interpretation and report only 2 ‫يساهم الصندوق‬
Cardiovascular stress test using maximal or submaximal treadmill or
93015 bicycle exercise, continuous ECG monitoring, and/or pharmacological 10 ‫يساهم الصندوق‬
stress: with physician supervision, with interpretation and report
Cardiovascular stress test using maximal or submaximal treadmill or
bicycle exercise, continuous ECG monitoring, and/or pharmacological
stress: with physician supervision only, without interpretation and report
93024 Ergonovine provocation test 8 ‫يساهم الصندوق‬
Vectorcardiogram (VCG), with or without ECG: with interpretation and
report
ECG monitoring for 24 hours by continuous computerized monitoring
93235 and non-continuous recording and real-time data analysis: includes 10 ‫يساهم الصندوق‬
monitoring and real time analysis with report and interpretation
93278 Signal-averaged electrocardiography (SAECG), with or without ECG 8 ‫يساهم الصندوق‬
Echocardiography, trans-thoracic, with or without M-mode recording,
with or without Doppler, with or without spectral color
Echocardiography, real time with image documentation (2D) with or
without M-mode recording: transesophageal
Combined right heart catheterization and retrograde left heart
catheterization
Echocardiography, 2D, with or without M-mode recording, during rest
93350 and cardiovascular stress test (maximal or submaximal treadmill or 15 ‫يساهم الصندوق‬
bicycle exercise), with ECG monitoring, interpretation, and report
93501 Right heart catheterization 25 ‫يساهم الصندوق‬
Insertion and placement of flow directed catheter (eg, Swan-Ganz) for
monitoring purposes
93505 Endomyocardial biopsy 30 ‫يساهم الصندوق‬
Left heart catheterization, retrograde, from the radial artery, brachial
93510 artery, axillary artery, or femoral artery: percutaneous or by surgical 40 ‫يساهم الصندوق‬
cutdown
93524 Combined transseptal and retrograde left heart catheterization 45 ‫يساهم الصندوق‬
Combined right heart catheterization and transseptal left heart
93527 catheterization through intact septum (with or without retrograde left 50 ‫يساهم الصندوق‬
heart catheterization)
93536 Percutaneous insertion of intra-aortic balloon catheter 50 ‫يساهم الصندوق‬
93546 Combined left heart catheterization and left ventricular angiography 40 ‫يتطلب موافقة‬
Combined left heart catheterization, selective coronary angiography, one
or more coronary arteries, and selective left ventricular angiography
93548 or more coronary arteries, selective left ventricular angiography, with 50 ‫يتطلب موافقة‬
aortic root aortography
Combined right and left heart catheterization, selective coronary
93549 angiography, one or more coronary arteries, and selective ventricular 60 ‫يتطلب موافقة‬
angiography
93552 or more coronary arteries, selective left ventricular cineangiography and 60 ‫يتطلب موافقة‬
visualization of bypass grafts
Esophageal recording of atrial electrogram ( with or without ventricular
electrogram)
Comprehensive electrophysiologic evaluation: right atrial and right
ventricular pacing and recording, His bundle recording, including
insertion and repositioning of multiple electrode catheters, without
induction or attempted induction of arrhyt
Comprehensive electrophysiologic evaluation with right atrial and right
insertion and repositioning of multiple electrode catheters: with induction
of arrhythmia
Comprehensive electrophysiologic evaluation with right atrial and right
insertion and repositioning of multiple electrode catheters: with left atrial
recordings from coronary sinus or
Electrophysiologic follow-up study with pacing and recording to test
93624 efficacy of therapy, including induction or attempted induction of 30 ‫يساهم الصندوق‬
arrhythmia
Electrophysiologic evaluation of cardioverter-defibrillator leads
93640 (includes de-fibrillation threshold testing and sensing function) at time 25 ‫يساهم الصندوق‬
of initial implantation or replacement
Electrophysiologic evaluation of cardioverter-defibrillator leads (includes
93641 defibrillation threshold testing and sensing function) at time of initial 35 ‫يساهم الصندوق‬
implantation or replacement, with testing of pulse generator
Electrophysiologic evaluation of cardioverter-defibrillator (evaluation of
defibrillation threshold, induction of arrhythmia, sensing and pacing for
arrhythmia termination, and programming of sensing or therapeutic
parametrs)
Intracardiac catheter ablation of atrioventricular node function,
93650 atrioventricular conduction for creation of complete heart block, with or 70 ‫يساهم الصندوق‬
without temporary pacemaker placement
Intracardiac catheter ablation of arrhythmogenic focus: for treatment of
93651 supraventricular tachycardia by ablation of fast or slow AV pathways, 110 ‫يساهم الصندوق‬
accessory AV connections or other atrial foci, singly or in combination
Intracardiac catheter ablation of arrhythmogenic focus: for treatment of
ventricular tachycardia
Evaluation of cardiovascular function with tilt table evaluation, with
93660 continuous ECG monitoring and intermittent blood pressure monitoring, 15 ‫يساهم الصندوق‬
with or without pharmacological intervention
Electronic analysis of dual-chamber or single chamber pacemaker system:
(evaluation of programmable parameters at rest and during activity if
applicable, using ECG recording and interpretation at rest and during
exercise, analysis of event markers an
Electronic analysis of cardioverter/defibrillator only (interrogation,
evaluation of pulse generator status: with or without reprogramming
Ambulatory blood pressure monitoring for 24 hours, including recording,
scanning analysis, interpretation and report
93792 Sphygmocardiography 8 ‫يساهم الصندوق‬
Non-invasive physiologic studies of extracranial arteries, bilateral
93875 (periorbital flow direction with arterial compression, ocular 3 ‫يساهم الصندوق‬
plethysmography,analog velocity waveform spectral analysis, Doppler)
93880 Duplex scan of extracranial arteries: complete bilateral study 15 ‫يساهم الصندوق‬
93882 Duplex scan of extracranial arteries: follow-up or limited study 10 ‫يساهم الصندوق‬
93886 Transcranial Doppler study of the intracranial arteries: complete study 20 ‫يساهم الصندوق‬
Transcranial Doppler study of the intracranial arteries: follow-up or
limited study
Non-invasive physiologic studies of extremity arteries, bilateral, without
exercise: upper extremity arteries
Non-invasive physiologic studies of extremity arteries, bilateral, without
exercise: lower extremity arteries
Non-invasive physiologic studies of extremity arteries, bilateral, with
exercise: upper extremity arteries
Non-invasive physiologic studies of extremity arteries, bilateral, with
exercise: lower extremity arteries
Duplex scan of lower extremity arteries or arterial bypass grafts:
complete bilateral study
Duplex scan of lower extremity arteries or arterial bypass grafts: follow-
up or limited study
Duplex scan of upper extremity arteries or arterial bypass grafts:
complete bilateral study
Duplex scan of upper extremity arteries or arterial bypass grafts: follow-
up or limited study
93965 Non-invasive physiologic studies of extremity veins, bilateral 5 ‫يساهم الصندوق‬
Duplex scan of extremity veins including responses to compression and
other maneuvers: complete study
Duplex scan of extremity veins including responses to compression and
other maneuvers: follow-up or limited study
Duplex scan of arterial inflow and venous outflow of abdominal, pelvic,
and/or retroperitoneal organs: complete study
Duplex scan of arterial inflow and venous outflow of abdominal, pelvic,
and/or retroperitoneal organs: follow-up or limited study
Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass
grafts: complete study
Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass
grafts: follow-up or limited study
93980 Duplex scan of penile and/or testicular vessels 10 ‫يساهم الصندوق‬
93981 Non-invasive physiologic studies of penile or testicular vessels 5 ‫يساهم الصندوق‬
93982 Contrast enhanced color Doppler abdominal scan 30 ‫يتطلب موافقة‬
93985 Trans cutaneous measurement of oxygen partial pressure (TcPO2) 5 ‫يساهم الصندوق‬
Spirometry, including graphic record, total and timed vital capacity,
94010 expiratory flow rate measurement(s), and/or maximal voluntary 2 ‫يساهم الصندوق‬
ventilation
Bronchospasm evaluation: before and after bronchodilator (aerosol or
parenteral) or exercise
Prolonged postexposure evaluation of bronchopasm with multiple
94070 spirometric determinations (aerosol only), antigen, exercise, cold air, 5 ‫يساهم الصندوق‬
methocholine
Vital capacity screening tests: total capacity, with timed forced expiratory
volume (state duration), maximal mid expiratory and peak flow rates
94200 Maximum breathing capacity, maximal voluntary ventilation 1 ‫يساهم الصندوق‬
Functional residual capacity or residual volume: helium method, nitrogen
open circuit method, or other method
94260 Thoracic gas volume (total lung capacity and residual volume) 3 ‫يساهم الصندوق‬
Determination of resistance to airflow, oscillatory or plethysmographic
method
94375 Respiratory flow volume loop 2 ‫يساهم الصندوق‬
94400 Breathing response to CO2 (CO2 response curve) 3 ‫يساهم الصندوق‬
94620 Pulmonary stress testing, simple or complex 8 ‫يساهم الصندوق‬
Ventilation assist and management for assist or controlled breathing:
initiation and first day (not in ICU, CCU or ICN)
Ventilation assist and management, subsequent days, per day (included in
ICU attendance fee if by same physician)
Continuous positive airway pressure ventilation (CPAP), initiation and
management, per day
94664 Aerosol or vapor inhalation or bronchodilation, per session 3 ‫يساهم الصندوق‬
Manipulation of chest wall eg, cupping, percussing, and vibration to
facilitate lung function, per session
Oxygen uptake, expired gas analysis: rest and exercise, direct, with or
without CO2 output, percentage oxygen extracted
Analysis of arterial blood gas (oxygen saturation, pO2, pCO2, CO2, pH):
rest only (per analysis)
Analysis of arterial blood gas (oxygen saturation, pO2, pCO2, CO2, pH):
rest and exercise (including cannulization of artery)
94720 Carbon monoxide diffusing capacity, any method 3 ‫يساهم الصندوق‬
94750 Pulmonary compliance study, any method 4 ‫يساهم الصندوق‬
Noninvasive ear or pulse oximetry for oxygen saturation: by continuous
overnight monitoring (separate procedure)
Circadian respiratory pattern recording, 12 to 24 hour continuous
recording
Percutaneous tests (scratch, puncture, prick) with allergenic extracts or
95004 antibiotics, immediate type reaction (allergen included), per test, up to 10 1 ‫يساهم الصندوق‬
tests
95027 Skin end point titration 4 ‫ال يساهم الصندوق‬
Intracutaneous (intradermal) tests with allergenic extracts, delayed type
reaction including reading and allergen, per test
95044 Patch or application tests, up to 10 tests, per test 1 ‫يساهم الصندوق‬
95052 Photo patch tests, up to 10 tests, per test 1 ‫يساهم الصندوق‬
95060 Opthalmic mucous membrane tests, per test 3 ‫يساهم الصندوق‬
95065 Direct nasal mucous membrane tests, per test 3 ‫يساهم الصندوق‬
Inhalation bronchial challenge testing (not including necessary
95070 pulmonary function tests): with histamine, methacholine, or similar 15 ‫يتطلب موافقة‬
compounds
Inhalation bronchial challenge testing (not including necessary
pulmonary function tests): with antigens or gases
Ingestion challenge test (sequential and incremental ingestion of test
items, eg, food, drug or other substance)
95078 Provocative testing (eg, Rinkel test) 5 ‫يتطلب موافقة‬
Professional services for allergen immunotherapy in prescribing
95120 physician's office or institution, including provision of allergenic extract, 5 ‫يتطلب موافقة‬
single antigen
Rapid desensitization procedure, each hour (eg, insulin, penicillin,
horse serum)
Multiple sleep latency testing (MSLT), recording, analysis and
95805 interpretation of physiological measurements of sleep during multiple nap 12 ‫ال يساهم الصندوق‬
opportunities
95807 Sleep study, 3 or more parameters of sleep other than sleep staging 12 ‫ال يساهم الصندوق‬
95808 Polysomnography: sleep staging with 1 - 3 additional parameters of sleep 15 ‫ال يساهم الصندوق‬
Polysomnography: sleep staging with 4 or more additional parameters of
sleep
95812 Electroencephalogram (EEG) extended monitoring: up to one hour 8 ‫ال يساهم الصندوق‬
95813 Electroencephalogram (EEG) extended monitoring: greater than one hour 12 ‫ال يساهم الصندوق‬
Electroencephalogram (EEG) including recording awake and drowsy,
with hyperventilation and/or photic stimulation
Electroenceohalogram (EEG) including recording awake and asleep, with
hyperventilation and/or photic stimulation
95822 Electroencephalogram (EEG): sleep only 9 ‫يساهم الصندوق‬
95824 Electroencephalogram (EEG): cerebral death evaluation only 5 ‫يساهم الصندوق‬
95827 Electroencephalogram (EEG): all night sleep only 11 ‫ال يساهم الصندوق‬
95829 Electrocorticogram at surgery (separate procedure) 40 ‫يساهم الصندوق‬
95830 Insertion by physician of sphenoidal electrodes for EEG recording 5 ‫ال يساهم الصندوق‬
95864 EMG-NCV, electromyography-nerve conduction velocity: extensive 15 ‫يساهم الصندوق‬
95869 EMG-NCV, electromyography-nerve conduction velocity: limited 10 ‫يساهم الصندوق‬
95920 Intraoperative neurophysiology testing, per hour 30 ‫ال يساهم الصندوق‬
Somatosensory testing (eg, cerebral evoked potentials), one or more
nerves
95933 Orbicularis oculi (blink) reflex, by electrodiagnostic testing 5 ‫ال يساهم الصندوق‬
Neuromuscular junction testing (repetitive stimulation, paired stimuli),
each nerve, any one method
Monitoring for identification and lateralization of cerebral seizure focus,
95950 electroencephalographic (eg, 8 channel EEG) recording and 10 ‫ال يساهم الصندوق‬
interpretation, each 24 hours
Monitoring for localization of cerebral seizure focus by cable or radio, 16
or more channel telemetry, combined electroencephalographic (EEG) and
video recording and interpretation (eg, for presurgical localization), each
24 hours
Monitoring for localization of cerebral seizure focus by computerized
95953 portable 16 or more channel EEG, electroencephalographic (EEG) 20 ‫ال يساهم الصندوق‬
recording and interpretation, each 24 hours
Pharmacological or physical activation requiring physician attendance
during EEG recording of activation phase (eg, thiopental activation test)
95955 Electroencephalogram (EEG) during non-intracranial (eg, carotid) surgery 7 ‫يساهم الصندوق‬
Monitoring for localization of cerebral seizure focus by cable or radio, 16
95956 or more channel telemetry, electroencephalographic recording and 20 ‫ال يساهم الصندوق‬
interpretation, each 24 hours
Digital analysis of electroencephalogram (EEG) (eg, for epileptic spike
analysis) list separately in addition to code for primary procedure
Wada activation test for hemispheric function, including
electroencephalographic (EEG) monitoring
Functional cortical mapping by stimulation of electrodes on brain surface,
95961 or of depth electrodes, to provoke seizures or identify vital cortex: initial 19 ‫ال يساهم الصندوق‬
hour of physician attendance
Functional cortical mapping by stimulation of electrodes on brain surface,
95962 or of depth electrodes, to provoke seizures or identify vital cortex: each 21 ‫ال يساهم الصندوق‬
additional hour of physician attendance
Electronic analysis of implanted neurostimulator pulse generator system
(eg. rate, pulse amplitude and duration, configuration of wave form,
battery status, electrode selectability, output modulation, cycling
impedance and patient measurements): comp
Electronic analysis of implanted neurostimulator pulse generator system
): complex brain, spinal cord or peripheral (except cranial nerve)
neurostimulator pulse generator/transmitter, with intraoperative or
subsequent programming: each additional 30
Psychological testing (includes psychodiagnostic assessment of
96100 personality, psychopathology, emotionality, intellectual abilities, eg, 12 ‫ال يساهم الصندوق‬
WAIS-R, Rorschach, MMPI) with interpretation and report
Assessment of aphasia (includes assessment of expressive and receptive
speech and language function, language comprehension, speech
production ability, reading, spelling, writing) with interpretation and
report
Developmental testing: extended (includes assessment of motor language,
social, adaptive and/or cognitive functioning by standardized
developmental instruments, eg, Bayley Scales of Infant Development)
with interpretation and report, per h
Neurobehavioral status exam (clinical assessment of thinking, reasoning
and judgment, eg,acquired knowledge, attention, memory, visual spatial
abilities, language functions, planning) with interpretation and report, per
hour
Neuropsychological testing battery (eg, Halstead-Reitan, Luria, WAIS-R)
with interpretation and report, per hour
Chemotherapy administration: subcutaneous or intramuscular, with or
without local anesthesia
Chemotherapy administration, intavenous, intra-arterial, or prolonged
infusion: initiation of a cycle (maximum once every two weeks)
Chemotherapy administration: intravenous or intra-arterial, subsequent
session, maximum of three sessions per month (per session)
96440 Chemotherapy administration into pleural cavity 15 ‫يساهم الصندوق‬
96445 Chemotherapy administration into peritoneal cavity 15 ‫يساهم الصندوق‬
96450 Chemotherapy administration into CNS (eg, intrathecal) 15 ‫يساهم الصندوق‬
High dose chemotherapy for hematopoietic stem cell mobilization or
transplantation
96530 Refilling and maintenance of implantable pump or reservoir 5 ‫يساهم الصندوق‬
97003 Occupational therapy evaluation 8 ‫ال يساهم الصندوق‬
97010 Application of a modality to one or more areas: hot or cold packs 2 ‫يتطلب موافقة‬
97012 Application of a modality to one or more areas: traction, mechanical 3 ‫يتطلب موافقة‬
97016 Application of a modality to one or more areas: vasopneumatic devices 2 ‫يتطلب موافقة‬
97018 Application of a modality to one or more areas: paraffin bath 1 ‫يتطلب موافقة‬
97020 Application of a modality to one or more areas: microwave 1 ‫يتطلب موافقة‬
97022 Application of a modality to one or more areas: whirlpool 2 ‫يتطلب موافقة‬
97024 Application of a modality to one or more areas: diathermy 1 ‫يتطلب موافقة‬
97026 Application of a modality to one or more areas: infrared 1 ‫يتطلب موافقة‬
97028 Application of a modality to one or more areas: ultraviolet 1 ‫يتطلب موافقة‬
Application of a modality to one or more areas: electrical stimulation
(manual), each 15 minutes
Application of a modality to one or more areas: iontophoresis, each 15
minutes
Application of a modality to one or more areas: contast baths, each 15
minutes
Application of a modality to one or more areas: ultrasound, each 15
minutes
Application of a modality to one or more areas: Hubbard tank, each 15
minutes
Therapeutic procedure, one or more areas, each 15 minutes: therapeutic
97110 exercises to develop strength and endurance, range of motion and 6 ‫يتطلب موافقة‬
flexibility
Therapeutic procedure, one or more areas, each 15 minutes:
97112 neuromuscular reeducation of movement, balance, coordination, 6 ‫يتطلب موافقة‬
kinesthetic sense, posture, and proprioception
Therapeutic procedure, one or more areas, each 15 minutes: aquatic
therapy with therapeutic exercises
Therapeutic procedure, one or more areas, each 15 minutes: gait training
(includes stair climbing)
Therapeutic procedure, one or more areas, each 15 minutes: massage
97124 including effleurage, petrissage, and/or tapotement (stroking, 5 ‫يتطلب موافقة‬
compression, percussion)
Manual therapy techniques (eg, mobilization/manipulation, manual
97140 lymphatic drainage, manual traction), one or more regions, each 15 6 ‫يتطلب موافقة‬
minutes
Orthotics fitting and training, upper and/or lower extremities, each 15
minutes
97520 Prosthetic training, upper and/or lower extremities, each 15 minutes 6 ‫يتطلب موافقة‬
97703 Checkout for orthotic/prosthetic use, established patient, each 15 minutes 3 ‫ال يساهم الصندوق‬
Physical performance test or measurement (eg, musculoskeletal,
functional capacity), with written report, each 15 minutes
Anesthesia with induced hypothermia by surface cooling to below 34? C,
add to regular fee
99135 Anesthesia with induced hypotension, add to regular fee 10 ‫يساهم الصندوق‬
99180 Hyperbaric oxygen therapy: initial management 25 ‫يساهم الصندوق‬
99183 Hyperbaric oxygen therapy: subsequent, per session 15 ‫يساهم الصندوق‬
99199 TPN - total parenteral nutrition, per day 10 ‫ال يساهم الصندوق‬
Newborn resuscitation: provision of positive pressure ventilation and/or
99440 chest compressions in the presence of acute inadequate ventilation and/or 20 ‫يساهم الصندوق‬
cardiac output (Apgar score below 5), with or without intubation
99500 Intrauterine fetal skin biopsy 20 ‫يساهم الصندوق‬
99501 Intrauterine fetal thoracocentesis 20 ‫يساهم الصندوق‬
99502 Intrauterine fetal urodochocentesis 20 ‫يساهم الصندوق‬
99503 Intrauterine cardiocentesis 20 ‫يساهم الصندوق‬
99504 Intrauterine drainage of polyhydramnios 20 ‫يساهم الصندوق‬
Glucose monitoring for 24 hours by continuous computerized monitoring
99505 recording and real-time data analysis: includes monitoring and real-time 10 ‫يساهم الصندوق‬
analysis with report and interpretation
99999 Gait and Motion ‫يتطلب موافقة‬

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Code Description K NSSF Coverage

Regional IV administration of local anesthetic agent to upper or lower

Venous thrombectomy, direct or with catheter: vena cava, iliac, or

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