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No Authorizationrequired List ofSurgical CPT codesand descriptionJanuary 12016Please note: All Medicare members must have a referral issued by theirPCP to see a Specialist; Out of Network providers please verify Memberbenefits prior to service 1-800-452-8633EffectiveJanuary 1,2016
2016 Surgical No Authorization Required List of CPT Codes with DescriptionCode 1190821908319084******NoteFine Needle aspiration; without imaging guidanceFine needle aspiration; with imaging guidanceImage-guided fluid collection drainage by catheterIncision and drainage of abscess ; simple or singleIncision and drainage of pilonidal cyst; simpleincision and drainage of pilonidal cyst; complicatedIncision and drainage of hematoma, seroma or fluid collectionIncision and drainage of hematoma, seroma or fluid collectionPuncture aspiration of abscess, hematoma, bulla or cystBiopsy of skin, subcutaneous tissue and/or mucous membrane; single lesionBiopsy of skin, subcutaneous tissue and/or mucous membrane each separate/additional lesionExcision, malignant lesion including margins, trunk, arms, or legs; excised diameter 0.5 cm or lessExcision, malignant lesion including margins, trunk, arms, or legs; excised diameter 0.6 to1.0 cmExcision, malignant lesion including margins, trunk, arms, or legs; excised diameter 1.1 to2.0 cmExcision, malignant lesion including margins, trunk, arms, or legs; excised diameter 2.1 to3.0 cmExcision, malignant lesion including margins, trunk, arms, or legs; excised diameter 3.1 to4.0 cmExcision, malignant lesion including margins, trunk, arms, or legs; excised diameter over4.0 cmExcision of pilonidal cyst or sinus; simpleExcision of pilonidal cyst or sinus; extensiveExcision of pilonidal cyst or sinus; complicatedRemoval of tissue expander(s) without insertion of prosthesisRepair, complex, scalp, arms, and/or legs; 1.1cm-2.5cmRepair, complex, scalp, arms, and/or legs; 2.6-7.5cmPuncture aspiration of cyst of breastPuncture aspiration of cyst of breast; each additional cyst (List separately in addition to code for primaryprocedure)Mastectomy with exploration or drainage of abscess; deepInjection procedure only for mammary ductogram or galactogramBiopsy, breast, with placement of breast localization device(s) when performed, and imaging of thebiopsy specimen, when performed, percutaneous; first lesion, including stereotactic guidanceBiopsy, breast, with placement of breast localization device(s) (e.g., clip, metallic pellet), whenperformed, and imaging of the biopsy specimen, when performed, percutaneous;Biopsy, breast, with placement of breast localization device(s) (e.g., clip, metallic pellet), whenperformed, and imaging of the biopsy specimen, when performed, percutaneous;Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed,and imaging of the biopsy specimen, when performed, percutaneous; each additional lesion, includingultrasound guidanceThese codes require prior authorization thru NIA’s Radiation Oncology Management Programwhen associated with Breast Cancer Treatment.Code is Not Payable if Performed in an Ambulatory Surgery Center (ASC).Auth required for Medicare through NCH for certain specialties1
2016 Surgical No Authorization Required List of CPT Codes with DescriptionCPT 928419285192861928719288DescriptionNoteBiopsy, breast, with placement of breast localization device(s)Biopsy, breast, with placement of breast localization deviceBiopsy of breast; percutaneous, needle core, not using imaging guidance (separateprocedure)Biopsy of breast, open, incisionalExcision of cyst, fibroadenoma, or other benign or malignant tumor, aberrantbreast tissue, duct lesion, nipple or areolar lesion (except 19300), open, male orfemale, 1 or more lesionsExcision of breast lesion identified by preoperative placement of radiologicalmarker, open; single lesionPlacement of breast localization device(s) (e.g., clip, metallic pellet, wire/needle,radioactive seeds), percutaneousPlacement of breast localization device(s), percutaneousPlacement of breast localization device(s), percutaneousPlacement of breast localization device(s) percutaneous; each additional lesion,including stereotactic guidancePlacement of breast localizationultrasound guidancePlacement of breast localizationPlacement of breast localizationPlacement of breast localizationdevice(s) percutaneous; first lesion, includingdevice(s) percutaneousdevice(s) percutaneousdevice(s) percutaneous19296Placement of radiotherapy after loading expandable catheter (single or multichannel) intothe breast for interstitial radioelement application following partial mastectomy, includesimaging guidance; on date separate from partial mastectomy**19297Placement of radiotherapy after loading expandable catheter (single or multichannel) intothe breast for interstitial radioelement application following partial mastectomy, includesimaging guidance; concurrent with partial mastectomy (List separately in addition tocode for primary procedure)19298Placement of radiotherapy after loading brachytherapy catheters (multiple tube andbutton type) into the breast for interstitial radioelement application following (at the timeof or subsequent to) partial mastectomy, includes imaging guidance*******These codes require prior authorization thru NIA’s Radiation Oncology Management Programwhen associated with Breast Cancer Treatment.Code is Not Payable if Performed in an Ambulatory Surgery Center (ASC).Auth required for Medicare through NCH for certain specialties2
2016 Surgical No Authorization Required List of CPT Codes with DescriptionCPT y, partial (e.g., lumpectomy, tylectomy, quadrantectomy, segmentectomy)Mastectomy partial (e.g., lumpectomy, tylectomy, quadrantectomy, with axillarylymphadenectomyMastectomy, simple, completeBiopsy, muscle, percutaneous needleBiopsy, bone, trocar, or needle; deep (e.g., vertebral body, femur)Biopsy, bone, open; superficial (e.g., ilium, sternum, spinous process, ribs, trochanterof femur)Biopsy, bone, open; deep (e.g., humerus, ischium, femur)Removal of foreign body in muscle or tendon sheath; deep or complicatedArthrocentesis, aspiration and/or injection; small joint or bursa (e.g., fingers, toes)Arthrocentesis, aspiration and/or injection, small joint or bursaArthrocentesis, aspiration and/or injection; intermediate joint or bursa (e.g.,temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa)Arthrocentesis, aspiration and/or injection, intermediate joint or bursaArthrocentesis, aspiration and/or injection; major joint or bursa (e.g., shoulder, hip,knee joint, subacromial bursa)Arthrocentesis, aspiration and/or injection, major joint or bursaAspiration and/or injection of ganglion cyst(s) any locationAspiration and injection for treatment of bone cystRemoval of implant; deep (e.g., buried wire, pin, screw, metal band, nail, rod or plate)Incision and drainage, deep abscess or hematoma, soft tissue of neck or thoraxBiopsy, soft tissue of neck or thoraxExcision, tumor, soft tissue of neck or anterior thorax, subcutaneous; less than 3 cmBiopsy, soft tissue of back or flank; superficialBiopsy, soft tissue of back or flank; deepExcision, tumor, soft tissue of back or flank, subcutaneous; less than 3 cmIncision and drainage, shoulder area; deep abscess or hematomaIncision and drainage, shoulder area; infected bursaBiopsy, soft tissue of shoulder area; superficialBiopsy, soft tissue of shoulder area; deepExcision, tumor, soft tissue of shoulder area, subfascial (eg, intramuscular); 5 cm orgreaterExcision, tumor, soft tissue of shoulder area, subcutaneous; less than 3 cmExcision, tumor, soft tissue of shoulder area, subfascial less than 5 cmRemoval of foreign body, shoulder; subcutaneousRemoval of foreign body, shoulder; deep (subfascial or intramuscular)Incision and drainage , upper arm or elbow area; deep abscess or hematomaIncision and drainage, upper arm or elbow area; bursaThese codes require prior authorization thru NIA’s Radiation Oncology Management Programwhen associated with Breast Cancer Treatment.Code is Not Payable if Performed in an Ambulatory Surgery Center (ASC).Auth required for Medicare through NCH for certain specialtiesNoteEffective08/15/20163
2016 Surgical No Authorization Required List of CPT Codes with DescriptionCPT 9876298772987929880******DescriptionNoteBiopsy, soft tissue of upper arm or elbow; superficialBiopsy, soft tissue of upper arm or elbow area; deep (subfascial or intramuscular)Excision, tumor, soft tissue of upper arm or elbow area, subcutaneous; less than 3 cmExcision, tumor, soft tissue of upper arm or elbow area, subfascial less than 5 cmRemoval of foreign body, upper arm or elbow area; subcutaneousRemoval of foreign body, upper arm or elbow area; deep (subfascial or intramuscular)Biopsy, soft tissue of forearm and/or wrist; superficialBiopsy, soft tissue forearm and/or wrist; deep (subfascial or intramuscular)Excision, tumor, soft tissue of forearm and/or wrist area, subcutaneous; less than 3 cmExcision, tumor, soft tissue of forearm and/or wrist area, subfascial less than 3 cmBiopsy, soft tissue of pelvis and hip area; superficialBiopsy, soft tissue thigh or knee; superficialBiopsy, soft tissue of thigh or knee area; deep (subfascial or intramuscular)Excision, tumor, soft tissue of thigh or knee area, subcutaneous; less than 3 cmBiopsy, soft tissue of leg or ankle; superficialBiopsy, soft tissue of leg or ankle area; deep (subfascial or intramuscular)Excision, tumor, soft tissue of leg or ankle area, subcutaneous; less than 3 cmCorrection, hallux valgus (bunion), with or without sesamoidectomy; simpleexostectomyCorrection, hallux valgus (bunion), with or without sesamoidectomy; Keller, McBride,or Mayo type procedureApplication, cast; elbow to finger (short arm)Removal or bivalving; full arm or full leg castArthroscopy, knee, surgical; osteochondral autograft(s) (e.g., mosaicplasty)Arthroscopy, knee, surgical; osteochondral allograft (e.g., mosaicplasty)Arthroscopy, knee, surgical; meniscal transplantation, medial or lateralArthroscopy, knee, diagnostic, with or without synovial biopsyArthroscopy, knee, surgical; for infection, lavage, and drainageArthroscopy, knee, surgical; with lateral releaseArthroscopy, knee, surgical; for removal of loose body or foreign body (e.g.,osteochondritis dissecans fragmentation, chondral fragmentation)Arthroscopy, knee, surgical; synovectomy, limited (e.g., plica or shelf resection)(separate procedure)Arthroscopy, knee, surgical; synovectomy, major, 2 or more compartments (e.g.,medial or lateralArthroscopy, knee, surgical; debridement/shaving of articular cartilage (chondroplasty)Arthroscopy, knee, surgical; abrasion arthroplasty (includes chondroplasty wherenecessary) or multiple drilling or microfractureArthroscopy, knee, surgical; with meniscectomyThese codes require prior authorization thru NIA’s Radiation Oncology Management Programwhen associated with Breast Cancer Treatment.Code is Not Payable if Performed in an Ambulatory Surgery Center (ASC).Auth required for Medicare through NCH for certain specialties****4
2016 Surgical No Authorization Required List of CPT Codes with DescriptionCPT 162231623******DescriptionNoteArthroscopy, knee, surgical; with meniscectomy (medial OR lateral, including anymeniscal shaving) including debridement/shaving of articular cartilage(chondroplasty), same or separate compartment(s), when performedArthroscopy, knee, surgical; with meniscus repair (medial OR lateral)Arthroscopy, knee, surgical; with meniscus repair (medial AND lateral)Arthroscopy, knee, surgical; with lysis of adhesions, with or without manipulation(separate procedure)Arthroscopy, knee, surgical; drilling for osteochondritis dissecans with bone grafting,with or without internal fixation (including debridement of base of lesion)Arthroscopy, knee, surgical; drilling for intact osteochondritis dissecans lesionArthroscopy, knee, surgical; drilling for intact osteochondritis dissecans lesion withinternal fixationDrainage abscess or hematoma, nasal, internal approachDrainage abscess or hematoma, nasal septumBiopsy , intranasalExcision, nasal polyp(s), simpleExcision, nasal polyp(s), extensiveNasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus orcanine fossa puncture)Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture ofsphenoidal face or cannulation of ostium)Nasal/sinus endoscopy, surgical; with biopsy, polypectomy or debridementLaryngoscopy, indirect; diagnostic (separate procedure)Laryngoscopy, indirect; with biopsyLaryngoscopy, indirect; with removal of foreign bodyLaryngoscopy, indirect; with removal of lesionLaryngoscopy, indirect; with vocal cord injectionLaryngoscopy, direct, operative, with biopsyLaryngoscopy, direct, with injection into vocal cord(s), therapeutic; with operatingmicroscope or telescopeLaryngoscopy, flexible fiberoptic; diagnosticLaryngoscopy, flexible fiberoptic; with biopsyLaryngoscopy, flexible fiberoptic; with removal of foreign bodyLaryngoscopy, flexible fiberoptic; with removal of lesionLaryngoscopy, flexible or rigid fiberoptic, with stroboscopyTracheobronchoscopy through established tracheostomy incisionBronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed;diagnostic, with cell washing, when performed (separate procedure)Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed;with brushing or protected brushingsThese codes require prior authorization thru NIA’s Radiation Oncology Management Programwhen associated with Breast Cancer Treatment.Code is Not Payable if Performed in an Ambulatory Surgery Center (ASC).Auth required for Medicare through NCH for certain specialties5
2016 Surgical No Authorization Required List of CPT Codes with DescriptionCPT Code316253162831629Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; withendobronchial ultrasound (ebus) guided transtracheal and/or transbronchial sampBronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; withendobronchial ultrasound (ebus) guided transtracheal and/or transbronchial samp316523165331654Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; withtransendoscopic endobronchial ultrasound (ebus) during bronchoscopic diagnosticBiopsy, pleura; percutaneous needleBiopsy, lung or mediastinum, percutaneous needleThoracentesis, needle or catheter, aspiration of the pleural space; without imagingguidanceThoracentesis, needle or catheter, aspiration of the pleural space; with imagingguidanceInsertion or replacement of temporary transvenous single chamber cardiac electrodeor pacemaker catheter (separate procedure)Insertion of pacemaker pulse generator only; with existing single leadInsertion of pacemaker pulse generator only; with existing dual leadsUpgrade of implanted pacemaker system, conversion of single chamber system todual chamber system (includes removal of previously placed pulse generator)Removal of permanent pacemaker pulse generatorTransfusion, blood or blood componentsInsertion of tunneled centrally inserted central venous access device, withsubcutaneous port; age 5 years or y, rigid or flexible, including fluoroscopic guidance, when performed;with bronchial alveolar lavageBronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; withbronchial or endobronchial biopsy(s), single or multiple sitesBronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed;with transbronchial lung biopsy(s), single lobeBronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; withtransbronchial needle aspiration biopsy(s), trachea, main stem and/or lobarbronchus(i)31624*DescriptionInsertion of tunneled centrally inserted central venous catheter, without subcutaneousport or pump; age 5 years or olderInsertion of peripherally inserted central venous catheter (PICC), withoutsubcutaneous port or pump; younger than 5 years of ageInsertion of peripherally inserted central venous catheter (PICC), withoutsubcutaneous port or pump; age 5 years or olderInsertion of peripherally inserted central venous access device, with subcutaneousport; younger than 5 years of ageThese codes require prior authorization thru NIA’s Radiation Oncology Management Programwhen associated with Breast Cancer Treatment.Code is Not Payable if Performed in an Ambulatory Surgery Center (ASC).Auth required for Medicare through NCH for certain specialties6
2016 Surgical No Authorization Required List of CPT Codes with DescriptionCPT tion of peripherally inserted central venous access device, with subcutaneous port;age 5 years or olderRepair of central venous access device, with subcutaneous port or pump, central orperipheral insertion siteRemoval of tunneled central venous catheter, without subcutaneous port or pumpRemoval of tunneled central venous access device, with subcutaneous port or pump,central or peripheral insertionDeclotting by thrombolytic agent of implanted vascular access device or catheterBone marrow; aspiration onlyBone marrow; biopsy, needle or trocarDrainage of lymph node abscess or lymphadenitis; simpleBiopsy or excision of lymph node(s); open, superficialBiopsy or excision of lymph node(s); by needle, superficial (e.g., cervical, inguinal,axillary)Biopsy or excision of lymph node(s); open, deep cervical node(s)Biopsy or excision of lymph node(s); open, deep cervical node(s) with excision scalenefat padBiopsy or excision of lymph node(s); open, deep axillary node(s)Axillary lymphadenectomy; superficialAxillary lymphadenectomy; completeInjection procedure; radioactive tracer for identification of sentinel nodeIntraoperative identification of sentinel lymph node(sBiopsy of lipBiopsy of tongue; anterior 2/3Biopsy of tongue; posterior 1/3Biopsy of floor of mouthExcision of lesion of tongue without closureDrainage of abscess of palate, uvulaBiopsy of palate, uvulaBiopsy of salivary gland; needleBiopsy of salivary gland; incisionalIncision and drainage abscess; peitonsillarBiopsy; oropharynxBiopsy; hypopharynxBiopsy; nasopharynx, visible lesion, simpleBiopsy; nasopharynx, survey for unknown primary lesionExcision or destruction of lesion of pharynx, any methodRemoval of foreign body from pharynxTonsillectomy and adenoidectomy; younger than age 12These codes require prior authorization thru NIA’s Radiation Oncology Management Programwhen associated with Breast Cancer Treatment.Code is Not Payable if Performed in an Ambulatory Surgery Center (ASC).Auth required for Medicare through NCH for certain specialties7
2016 Surgical No Authorization Required List of CPT Codes with DescriptionCPT CodeDescription42821Tonsillectomy and adenoidectomy; age 12 or over4282542826428304283142836Tonnsillectomy, primary or secondary; younger than age 12Tonsillectomy, primary or secondary, age 12 or overAdenoidectomy, primary; younger than age 12Adenoidectomy, primary; age 12 or overAdenoidectomy, secondary; age 12 or overEsophagoscopy, rigid, transoral with diverticulectomy of hypopharynxEsophagoscopy, rigid, transoral; diagnostic, including collection of specimen(s) bybrushing or washing when performed (separate procedure)Esophagoscopy, rigid, transoral; with directed submucosal injection(s), any substanceEsophagoscopy, rigid, transoral; with biopsy, single or multipleEsophagoscopy, rigid, transoral; with removal of foreign bodyEsophagoscopy, rigid, transoral; with balloon dilation (less than 30 mm diameter)Esophagoscopy, rigid, transoral; with insertion of guide wire followed by dilation overguide wireEsophagoscopy, flexible, transnasal; diagnostic, includes collection of specimen(s) bybrushing or washing when performed (separate procedure)Esophagoscopy, flexible, transnasal; with biopsy, single or multipleEsophagoscopy, rigid or flexible; diagnostic, with or without collection of specimen(s)by brushing or washing (separate procedure)Esophagoscopy, rigid or flexible; with directed submucosal injection(s), any substanceEsophagoscopy, rigid or flexible; with injection sclerosis of esophageal varicesEsophagoscopy, rigid or flexible; with band ligation of esophageal varicesEsophagoscopy, flexible, transoral; with endoscopic mucosal resectionEsophagoscopy, flexible, transoral; with placement of endoscopic stent (includes preand post-dilation and guide wire passage, when performedEsophagoscopy, flexible, transoral; with dilation of esophagus, by balloon or dilator,retrograde (includes fluoroscopic guidance, when performed)Esophagoscopy, flexible, transoral; with dilation of esophagus with balloon (30 mmdiameter or larger) (includes fluoroscopic guidance, when performed)Esophagoscopy, rigid or flexible; with removal of foreign bodyEsophagoscopy, rigid or flexible; with removal of tumor(s), poly(s) or other lesion(s) byhot biopsy forceps or bipolar cauteryEsophagoscopy, rigid or flexible; with removal of tumor(s), polyp(s), or other lesion(s)by snare techniqueLeft blank intentionallyEsophagoscopy, rigid or flexible; with balloon dilation (less than 30 mm diameter)Esophagoscopy, rigid or flexible; with insertion of guide wire followed by dilation overguide 32174322043226******These codes require prior authorization thru NIA’s Radiation Oncology Management Programwhen associated with Breast Cancer Treatment.Code is Not Payable if Performed in an Ambulatory Surgery Center (ASC).Auth required for Medicare through NCH for certain specialtiesNote8
2016 Surgical No Authorization Required List of CPT Codes with DescriptionCPT CodeDescriptionNoteEsophagoscopy, rigid or flexible; with control of bleeding43227Left blank 2384323943240432414324243243******Esophagoscopy, flexible, transoral; with ablation of tumor(s), (s), polyp(s), or otherlesion(s) (includes pre- and post-dilation and guide wire passage, when performed)Esophagoscopy, rigid or flexible; with endoscopic ultrasound examinationEsophagoscopy, rigid or flexible; with transendoscopic ultrasound-guided intramuralor transmural fine needle aspiration/biopsy(s)Esophagogastroduodenoscopy, flexible, transoral; with dilation of esophagus withballoon (30 mm diameter or larger) (includes fluoroscopic guidance, when performed)Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection ofspecimen(s) by brushing or washing, when performed (separate procedure)Upper gastrointestinal endoscopy including esophagus, stomach, and either theduodenum and/or jejunum as appropriate; with directed submucosal injection(s), anysubstanceUpper gastrointestinal endoscopy including esophagus, stomach, and either theduodenum and/or jejunum as appropriate; with endoscopic ultrasound examinationlimited to the esophagusUpper gastrointestinal endoscopy including esophagus, stomach, and either theduodenum and/or jejunum as appropriate; with transendoscopic ultrasound-guidedintramural or transmural fine needle aspiration/biopsy(s), esophagus ultrasoundexamination limited to the esophagus)Upper gastrointestinal endoscopy including esophagus, stomach, and either theduodenum and/or jejunum as appropriate; with biopsy, single or multipleUpper gastrointestinal endoscopy including esophagus, stomach, and either theduodenum and/or jejunum as appropriate; with transmural drainage of pseudocystUpper gastrointestinal endoscopy including esophagus, stomach, and either theduodenum and/or jejunum as appropriate; with transendoscopic intraluminal tube orcatheter placementUpper gastrointestinal endoscopy including esophagus, stomach, and either theduodenum and/or jejunum as appropriate; with transendoscopic ultrasound-guidedintramural or transmural fine needle aspiration/biopsy(s) (includes endoscopicultrasound examination of the esophagus, stomach, and either the duodenum and/orjejunum as appropriate)Upper gastrointestinal endoscopy including esophagus, stomach, and either theduodenum and/or jejunum as appropriate; with injection sclerosis of esophagealand/or gastric varicesThese codes require prior authorization thru NIA’s Radiation Oncology Management Programwhen associated with Breast Cancer Treatment.Code is Not Payable if Performed in an Ambulatory Surgery Center (ASC).Auth required for Medicare through NCH for certain specialties9
2016 Surgical No Authorization Required List of CPT Codes with DescriptionCPT CodeDescription43244Upper gastrointestinal endoscopy including esophagus, stomach, and either theduodenum and/or jejunum as appropriate; with band ligation of esophageal and/orgastric varices43245Upper gastrointestinal endoscopy including esophagus, stomach, and either theduodenum and/or jejunum as appropriate; with dilation of gastric outlet forobstruction (e.g., balloon, guide wire, bougie)43246Upper gastrointestinal endoscopy including esophagus, stomach, and either theduodenum and/or jejunum as appropriate; with directed placement of percutaneousgastrostomy tube43247Upper gastrointestinal endoscopy including esophagus, stomach, and either theduodenum and/or jejunum as appropriate; with removal of foreign body43248Upper gastrointestinal endoscopy including esophagus, stomach, and either theduodenum and/or jejunum as appropriate; with insertion of guide wire followed bydilation of esophagus over guide wire43249Upper gastrointestinal endoscopy including esophagus, stomach, and either theduodenum and/or jejunum as appropriate; with balloon dilation of esophagus (lessthan 30 mm diameter)43250Upper gastrointestinal endoscopy including esophagus, stomach, and either theduodenum and/or jejunum as appropriate; with removal of tumor(s), polyp(s), or otherlesion(s) by hot biopsy forceps or bipolar cautery43251Upper gastrointestinal endoscopy including esophagus, stomach, and either theduodenum and/or jejunum as appropriate; with removal of tumor(s), polyp(s), or otherlesion(s) by snare technique43253Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic ultrasoundguided transmural injection43254Esophagogastroduodenoscopy, flexible, transoral; with endoscopic mucosal resection4325543259******NoteUpper gastrointestinal endoscopy including esophagus, stomach, and eitherthe duodenum and/or jejunum as appropriate; with control of bleedingLeft blank intentionallyUpper gastrointestinal endoscopy including esophagus, stomach, and either theduodenum and/or jejunum as appropriate; with endoscopic ultrasound examination,These codes require prior authorization thru NIA’s Radiation Oncology Management Programwhen associated with Breast Cancer Treatment.Code is Not Payable if Performed in an Ambulatory Surgery Center (ASC).Auth required for Medicare through NCH for certain specialties10
2016 Surgical No Authorization Required List of CPT Codes with DescriptionCPT CodeDescription43260Endoscopic retrograde cholangiopancreatography (ERCP); diagnostic, with or withoutcollection of specimen(s) by brushing or washing (separate procedure)43262Endoscopic retrograde cholangiopancreatography (ERCP); withsphincterotomy/papillotomyEndoscopic retrograde cholangiopancreatography (ERCP); with pressure measurementof sphincter of Oddi (pancreatic duct or common bile duct)Endoscopic retrograde cholangiopancreatography (ERCP); with endoscopic retrograderemoval of calculus/calculi from biliary and/or pancreatic ductsEndoscopic retrograde cholangiopancreatography (ERCP); with endoscopic retrogradedestruction, lithotripsy of calculus/calculi, any methodEsophagogastroduodenoscopy, flexible, transoral; with placement of endoscopic stentEsophagogastroduodenoscopy, flexible, transoral; with ablation of tumor(s), polyp(s),or other lesion(s)Endoscopic retrograde cholangiopancreatography (ERCP); with placement of endoscopicstent into biliary or pancreatic duct, including pre- and post-dilation and guide wirepassage, when performed, including sphincterotomy, when performed, each copic retrograde cholangiopancreatography (ERCP); with removal of foreignbody(s) or stent(s) from biliary/pancreatic duct(s)Endoscopic retrograde cholangiopancreatography (ERCP); with removal andexchange of stent(s), biliary or pancreatic duct, including pre- and post-dilation andguide wire passage.Endoscopic retrograde cholangiopancreatography (ERCP); with trans-endoscopicballoon dilation of biliary/pancreatic duct(s) or of ampulla (sphincteroplasty)Endoscopic retrograde cholangiopancreatography (ERCP); with ablation of tumor(s),polyp(s), or other lesion(s).Dilation of esophagus, by unguided sound or bougie, single or multiple passesDilation of esophagus, over guide wireChange of gastrostomy tube, percutaneous, without imaging or endoscopic guid
These codes require prior authorization thru NIA's Radiation Oncology Management Program when associated with Breast Cancer Treatment. ** Code is Not Payable if Performed in an Ambulatory Surgery Center (ASC). *** Auth required for Medicare through NCH for certain specialties : 2016 Surgical No Authorization Required List of CPT Codes with .
