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Medicare Risk Adjustment Model CPT/HCPCS Filtering Included List,Calendar Year (CY) 2016, Quarter 4 (October)CPT only copyright 2016 American Medical Association. All rightsreserved.In CY2016 Q4HCPCS/CPT CodeShort DescriptionIncluded List?C5271Low cost skin substitute appyesC5273Low cost skin substitute appyesC5275Low cost skin substitute appyesC5277Low cost skin substitute appyesC9600Perc drug-el cor stent singyesC9602Perc d-e cor stent ather syesC9604Perc d-e cor revasc t cabg syesC9606Perc d-e cor revasc w ami syesyesC9607Perc d-e cor revasc chro sinC9727Insert palate implantsyesC9734U/s trtmt, not leiomyomatayesC9739Cystoscopy prostatic imp 1-3yesC9740Cysto impl 4 or moreyesC9741Impl pressure sensor w/angioyesC9742Laryngoscopy with injectionyesC9743Bulking/spacer material implyesC9800Dermal filler inj px/supplyesG0129Partial hosp prog serviceyesG0151Hhcp-serv of pt,ea 15 minyesG0152Hhcp-serv of ot,ea 15 minyesG0153Hhcp-svs of s/l path,ea 15mnyesG0155Hhcp-svs of csw,ea 15 minyesG0159Hhc pt maint ea 15 minyesG0160Hhc occup therapy ea 15yesG0161Hhc slp ea 15 minyesG0186Dstry eye lesn,fdr vssl techyesG0245Initial foot exam pt lopsyesyesG0246Followup eval of foot pt lopG0248Demonstrate use home inr monyesG0249Provide inr test mater/equipyesyesG0250Md inr test revie inter mgmtG0257Unsched dialysis esrd pt hosyesG0259Inject for sacroiliac jointyesInj for sacroiliac jt anesthyesG0260G0268Removal of impacted wax mdyesG0276Pild/placebo control clin tryesG0339Robot lin-radsurg com, firstyesG0340Robt lin-radsurg fractx 2-5yesG0341Percutaneous islet celltransyesG0342Laparoscopy islet cell transyes2016 Q4 Medicare CPT HCPCS2016 Medicare CPT HCPC List.xlsx1 of 160
Medicare Risk Adjustment Model CPT/HCPCS Filtering Included List,Calendar Year (CY) 2016, Quarter 4 (October)CPT only copyright 2016 American Medical Association. All rightsreserved.In CY2016 Q4HCPCS/CPT CodeShort DescriptionIncluded List?G0343Laparotomy islet cell transpyesG0372Md service required for pmdyesG0378Hospital observation per hryesG0379Direct refer hospital observyesG0380Lev 1 hosp type b ed visityesG0381Lev 2 hosp type b ed visityesG0382Lev 3 hosp type b ed visityesG0383Lev 4 hosp type b ed visityesyesG0384Lev 5 hosp type b ed visitG0396Alcohol/subs interv 15-30mnyesG0397Alcohol/subs interv 30 minyesG0402Initial preventive examyesG0406Inpt/tele follow up 15yesG0407Inpt/tele follow up 25yesG0408Inpt/tele follow up 35yesG0409Corf related serv 15 mins eayesG0412Open tx iliac spine uni/bilyesG0413Pelvic ring fracture uni/bilyesG0414Pelvic ring fx treat int fixyesG0415Open tx post pelvic fxctureyesG0425Inpt/ed teleconsult30yesG0426Inpt/ed teleconsult50yesG0427Inpt/ed teleconsult70yesG0429Dermal filler injection(s)yesG0438Ppps, initial visityesG0439Ppps, subseq visityesG0443Brief alcohol misuse counselyesyesG0447Behavior counsel obesity 15mG0448Place perm pacing cardiovertyesG0455Fecal microbiota prep instilyesyesG0458Ldr prostate brachy comp ratG0459Telehealth inpt pharm mgmtyesG0460Autologous prp for ulcersyesHospital outpt clinic visityesG0463G0466Fqhc visit new patientyesG0467Fqhc visit, estab ptyesG0468Fqhc visit, ippe or awvyesG0469Fqhc visit, mh new ptyesG0470Fqhc visit, mh estab ptyesG0473Group behave couns 2-10yes2016 Q4 Medicare CPT HCPCS2016 Medicare CPT HCPC List.xlsx2 of 160
Medicare Risk Adjustment Model CPT/HCPCS Filtering Included List,Calendar Year (CY) 2016, Quarter 4 (October)CPT only copyright 2016 American Medical Association. All rightsreserved.In CY2016 Q4HCPCS/CPT CodeShort DescriptionIncluded List?G0498Chemo extend iv infus w/pumpyesG3001Admin supply, tositumomabyesG6003Radiation treatment deliveryyesG6004Radiation treatment deliveryyesG6005Radiation treatment deliveryyesG6006Radiation treatment deliveryyesG6007Radiation treatment deliveryyesG6008Radiation treatment deliveryyesyesG6009Radiation treatment deliveryG6010Radiation treatment deliveryyesG6011Radiation treatment deliveryyesG6012Radiation treatment deliveryyesG6013Radiation treatment deliveryyesG6014Radiation treatment deliveryyesG6015Radiation tx delivery imrtyesG6016Delivery comp imrtyesG9481Remote E/M new pt 10minsyesG9482Remote E/M new pt 20minsyesG9483Remote E/M new pt 30minsyesG9484Remote E/M new pt 45minsyesG9485Remote E/M new pt 60minsyesG9486Remote E/M est. pt 10minsyesG9487Remote E/M est. pt 15minsyesG9488Remote E/M est. pt 25minsyesG9489Remote E/M est. pt 40minsyesG9679Acute care pneumoniayesG9680Acute care congestive heartyesyesG9681Acute care chronic obstructG9682Acute care skin infectionyesG9683Acute care fluid or electrolyesyesG9684Acute care urinary tract infG9685Acute nursing facility careyesM0075Cellular therapyyesProlotherapyyesM0076M0100Intragastric hypothermiayesM0300Iv chelationtherapyyesM0301Fabric wrapping of aneurysmyes00100Anesth salivary glandyes00102Anesth repair of cleft lipyes00103Anesth blepharoplastyyes2016 Q4 Medicare CPT HCPCS2016 Medicare CPT HCPC List.xlsx3 of 160
Medicare Risk Adjustment Model CPT/HCPCS Filtering Included List,Calendar Year (CY) 2016, Quarter 4 (October)CPT only copyright 2016 American Medical Association. All rightsreserved.In CY2016 Q4HCPCS/CPT CodeShort DescriptionIncluded List?00104Anesth electroshockyes00120Anesth ear surgeryyes00124Anesth ear examyes00126Anesth tympanotomyyes00140Anesth procedures on eyeyes00142Anesth lens surgeryyes00144Anesth corneal transplantyes00145Anesth vitreoretinal surgyesyes00147Anesth iridectomy00148Anesth eye examyes00160Anesth nose/sinus surgeryyes00162Anesth nose/sinus surgeryyes00164Anesth biopsy of noseyes00170Anesth procedure on mouthyes00172Anesth cleft palate repairyes00174Anesth pharyngeal surgeryyes00176Anesth pharyngeal surgeryyes00190Anesth face/skull bone surgyes00192Anesth facial bone surgeryyes00210Anesth cranial surg nosyes00211Anesth cran surg hemotomayes00212Anesth skull drainageyes00214Anesth skull drainageyes00215Anesth skull repair/fractyes00216Anesth head vessel surgeryyes00218Anesth special head surgeryyes00220Anesth intrcrn nerveyesyes00222Anesth head nerve surgery00300Anesth head/neck/ptrunkyes00320Anesth neck organ 1yr/ yesyes00322Anesth biopsy of thyroid00326Anesth larynx/trach 1 yryes00350Anesth neck vessel surgeryyesAnesth neck vessel surgeryyes0035200400Anesth skin ext/per/atrunkyes00402Anesth surgery of breastyes00404Anesth surgery of breastyes00406Anesth surgery of breastyes00410Anesth correct heart rhythmyes00450Anesth surgery of shoulderyes2016 Q4 Medicare CPT HCPCS2016 Medicare CPT HCPC List.xlsx4 of 160
Medicare Risk Adjustment Model CPT/HCPCS Filtering Included List,Calendar Year (CY) 2016, Quarter 4 (October)CPT only copyright 2016 American Medical Association. All rightsreserved.In CY2016 Q4HCPCS/CPT CodeShort DescriptionIncluded List?00454Anesth collar bone biopsyyes00470Anesth removal of ribyes00472Anesth chest wall repairyes00474Anesth surgery of ribyes00500Anesth esophageal surgeryyes00520Anesth chest procedureyes00522Anesth chest lining biopsyyes00524Anesth chest drainageyesyes00528Anes mediascpy & dx thorscpy00529Anes medscpy&thorscpy 1 lungyes00530Anesth pacemaker insertionyes00532Anesth vascular accessyes00534Anesth cardioverter/defibyes00537Anesth cardiac electrophysyes00539Anesth trach-bronch reconstyes00540Anesth chest surgeryyes00541Anesth one lung ventilationyes00542Anesthesia removal pleurayes00546Anesth lung chest wall surgyes00548Anesth trachea bronchi surgyes00550Anesth sternal debridementyes00560Anesth heart surg w/o pumpyes00561Anesth heart surg 1 yryes00562Anesth hrt surg w/pmp age 1 yes00563Anesth heart surg w/arrestyes00566Anesth cabg w/o pumpyes00567Anesth cabg w/pumpyesyes00580Anesth heart/lung transplnt00600Anesth spine cord surgeryyes00604Anesth sitting procedureyesyes00620Anesth spine cord surgery00625Anes spine tranthor w/o ventyes00626Anes spine transthor w/ventyesAnesth spine cord surgeryyes0063000632Anesth removal of nervesyes00635Anesth lumbar punctureyes00640Anesth spine manipulationyes00670Anesth spine cord surgeryyes00700Anesth abdominal wall surgyes00702Anesth for liver biopsyyes2016 Q4 Medicare CPT HCPCS2016 Medicare CPT HCPC List.xlsx5 of 160
Medicare Risk Adjustment Model CPT/HCPCS Filtering Included List,Calendar Year (CY) 2016, Quarter 4 (October)CPT only copyright 2016 American Medical Association. All rightsreserved.In CY2016 Q4HCPCS/CPT CodeShort DescriptionIncluded List?00730Anesth abdominal wall surgyes00740Anesth upper gi visualizeyes00750Anesth repair of herniayes00752Anesth repair of herniayes00754Anesth repair of herniayes00756Anesth repair of herniayes00770Anesth blood vessel repairyes00790Anesth surg upper abdomenyesyes00792Anesth hemorr/excise liver00794Anesth pancreas removalyes00796Anesth for liver transplantyes00797Anesth surgery for obesityyes00800Anesth abdominal wall surgyes00802Anesth fat layer removalyes00810Anesth low intestine scopeyes00820Anesth abdominal wall surgyes00830Anesth repair of herniayes00832Anesth repair of herniayes00834Anesth hernia repair 1 yryes00836Anesth hernia repair preemieyes00840Anesth surg lower abdomenyes00842Anesth amniocentesisyes00844Anesth pelvis surgeryyes00846Anesth hysterectomyyes00848Anesth pelvic organ surgyes00851Anesth tubal ligationyes00860Anesth surgery of abdomenyesyes00862Anesth kidney/ureter surg00864Anesth removal of bladderyes00865Anesth removal of prostateyesyes00866Anesth removal of adrenal00868Anesth kidney transplantyes00870Anesth bladder stone surgyesAnesth kidney stone destructyes0087200873Anesth kidney stone destructyes00880Anesth abdomen vessel surgyes00882Anesth major vein ligationyes00902Anesth anorectal surgeryyes00904Anesth perineal surgeryyes00906Anesth removal of vulvayes2016 Q4 Medicare CPT HCPCS2016 Medicare CPT HCPC List.xlsx6 of 160
Medicare Risk Adjustment Model CPT/HCPCS Filtering Included List,Calendar Year (CY) 2016, Quarter 4 (October)CPT only copyright 2016 American Medical Association. All rightsreserved.In CY2016 Q4HCPCS/CPT CodeShort DescriptionIncluded List?00908Anesth removal of prostateyes00910Anesth bladder surgeryyes00912Anesth bladder tumor surgyes00914Anesth removal of prostateyes00916Anesth bleeding controlyes00918Anesth stone removalyes00920Anesth genitalia surgeryyes00921Anesth vasectomyyesyes00922Anesth sperm duct surgery00924Anesth testis explorationyes00926Anesth removal of testisyes00928Anesth removal of testisyes00930Anesth testis suspensionyes00932Anesth amputation of penisyes00934Anesth penis nodes removalyes00936Anesth penis nodes removalyes00938Anesth insert penis deviceyes00940Anesth vaginal proceduresyes00942Anesth surg on vag/urethralyes00944Anesth vaginal hysterectomyyes00948Anesth repair of cervixyes00950Anesth vaginal endoscopyyes00952Anesth hysteroscope/graphyes01112Anesth bone aspirate/bxyes01120Anesth pelvis surgeryyes01130Anesth body cast procedureyes01140Anesth amputation at pelvisyesyes01150Anesth pelvic tumor surgery01160Anesth pelvis procedureyes01170Anesth pelvis surgeryyesyes01173Anesth fx repair pelvis01180Anesth pelvis nerve removalyes01190Anesth pelvis nerve removalyesAnesth hip joint procedureyes0120001202Anesth arthroscopy of hipyes01210Anesth hip joint surgeryyes01212Anesth hip disarticulationyes01214Anesth hip arthroplastyyes01215Anesth revise hip repairyes01220Anesth procedure on femuryes2016 Q4 Medicare CPT HCPCS2016 Medicare CPT HCPC List.xlsx7 of 160
Medicare Risk Adjustment Model CPT/HCPCS Filtering Included List,Calendar Year (CY) 2016, Quarter 4 (October)CPT only copyright 2016 American Medical Association. All rightsreserved.In CY2016 Q4HCPCS/CPT CodeShort DescriptionIncluded List?01230Anesth surgery of femuryes01232Anesth amputation of femuryes01234Anesth radical femur surgyes01250Anesth upper leg surgeryyes01260Anesth upper leg veins surgyes01270Anesth thigh arteries surgyes01272Anesth femoral artery surgyes01274Anesth femoral embolectomyyesyes01320Anesth knee area surgery01340Anesth knee area procedureyes01360Anesth knee area surgeryyes01380Anesth knee joint procedureyes01382Anesth dx knee arthroscopyyes01390Anesth knee area procedureyes01392Anesth knee area surgeryyes01400Anesth knee joint surgeryyes01402Anesth knee arthroplastyyes01404Anesth amputation at kneeyes01420Anesth knee joint castingyes01430Anesth knee veins surgeryyes01432Anesth knee vessel surgyes01440Anesth knee arteries surgyes01442Anesth knee artery surgyes01444Anesth knee artery repairyes01462Anesth lower leg procedureyes01464Anesth ankle/ft arthroscopyyes01470Anesth lower leg surgeryyesyes01472Anesth achilles tendon surg01474Anesth lower leg surgeryyes01480Anesth lower leg bone surgyesyes01482Anesth radical leg surgery01484Anesth lower leg revisionyes01486Anesth ankle replacementyesAnesth lower leg castingyes0149001500Anesth leg arteries surgyes01502Anesth lwr leg embolectomyyes01520Anesth lower leg vein surgyes01522Anesth lower leg vein surgyes01610Anesth surgery of shoulderyes01620Anesth shoulder procedureyes2016 Q4 Medicare CPT HCPCS2016 Medicare CPT HCPC List.xlsx8 of 160
Medicare Risk Adjustment Model CPT/HCPCS Filtering Included List,Calendar Year (CY) 2016, Quarter 4 (October)CPT only copyright 2016 American Medical Association. All rightsreserved.In CY2016 Q4HCPCS/CPT CodeShort DescriptionIncluded List?01622Anes dx shoulder arthroscopyyes01630Anesth surgery of shoulderyes01634Anesth shoulder joint amputyes01636Anesth forequarter amputyes01638Anesth shoulder replacementyes01650Anesth shoulder artery surgyes01652Anesth shoulder vessel surgyes01654Anesth shoulder vessel surgyesyes01656Anesth arm-leg vessel surg01670Anesth shoulder vein surgyes01680Anesth shoulder castingyes01682Anesth airplane castyes01710Anesth elbow area surgeryyes01712Anesth uppr arm tendon surgyes01714Anesth uppr arm tendon surgyes01716Anesth biceps tendon repairyes01730Anesth uppr arm procedureyes01732Anesth dx elbow arthroscopyyes01740Anesth upper arm surgeryyes01742Anesth humerus surgeryyes01744Anesth humerus repairyes01756Anesth radical humerus surgyes01758Anesth humeral lesion surgyes01760Anesth elbow replacementyes01770Anesth uppr arm artery surgyes01772Anesth uppr arm embolectomyyes01780Anesth upper arm vein surgyesyes01782Anesth uppr arm vein repair01810Anesth lower arm surgeryyes01820Anesth lower arm procedureyesyes01829Anesth dx wrist arthroscopy01830Anesth lower arm surgeryyes01832Anesth wrist replacementyesAnesth lwr arm artery surgyes0184001842Anesth lwr arm embolectomyyes01844Anesth vascular shunt surgyes01850Anesth lower arm vein surgyes01852Anesth lwr arm vein repairyes01860Anesth lower arm castingyes01916Anesth dx arteriographyyes2016 Q4 Medicare CPT HCPCS2016 Medicare CPT HCPC List.xlsx9 of 160
Medicare Risk Adjustment Model CPT/HCPCS Filtering Included List,Calendar Year (CY) 2016, Quarter 4 (October)CPT only copyright 2016 American Medical Association. All rightsreserved.In CY2016 Q4HCPCS/CPT CodeShort DescriptionIncluded List?01920Anesth catheterize heartyes01922Anesth cat or mri scanyes01924Anes ther interven rad artrlyes01925Anes ther interven rad cardyes01926Anes tx interv rad hrt/cranyes01930Anes ther interven rad veinyes01931Anes ther interven rad tipsyes01932Anes tx interv rad th veinyesyes01933Anes tx interv rad cran vein01935Anesth perc img dx sp procyes01936Anesth perc img tx sp procyes01951Anesth burn less 4 percentyes01952Anesth burn 4-9 percentyes01958Anesth antepartum manipulyes01960Anesth vaginal deliveryyes01961Anesth cs deliveryyes01962Anesth emer hysterectomyyes01963Anesth cs hysterectomyyes01965Anesth inc/missed ab procyes01967Anesth/analg vag deliveryyes01990Support for organ donoryes01991Anesth nerve block/injyes01992Anesth n block/inj proneyes01996Hosp manage cont drug adminyes01999Unlisted anesth procedureyes10021Fna w/o imageyes10022Fna w/imageyesyes10030Guide cathet fluid drainage10040Acne surgeryyes10060Drainage of skin abscessyesyes10061Drainage of skin abscess10080Drainage of pilonidal cystyes10081Drainage of pilonidal cystyesRemove foreign bodyyes1012010121Remove foreign bodyyes10140Drainage of hematoma/fluidyes10160Puncture drainage of lesionyes10180Complex drainage woundyes11000Debride infected skinyes11004Debride genitalia & perineumyes2016 Q4 Medicare CPT HCPCS2016 Medicare CPT HCPC List.xlsx10 of 160
Medicare Risk Adjustment Model CPT/HCPCS Filtering Included List,Calendar Year (CY) 2016, Quarter 4 (October)CPT only copyright 2016 American Medical Association. All rightsreserved.In CY2016 Q4HCPCS/CPT CodeShort DescriptionIncluded List?11005Debride abdom wallyes11006Debride genit/per/abdom wallyes11010Debride skin at fx siteyes11011Debride skin musc at fx siteyes11012Deb skin bone at fx siteyes11042Deb subq tissue 20 sq cm/ yes11043Deb musc/fascia 20 sq cm/ yes11044Deb bone 20 sq cm/ yesyes11055Trim skin lesion11056Trim skin lesions 2 to 4yes11057Trim skin lesions over 4yes11200Removal of skin tags w/15yes11300Shave skin lesion 0.5 cm/ yes11301Shave skin lesion 0.6-1.0 cmyes11302Shave skin lesion 1.1-2.0 cmyes11303Shave skin lesion 2.0 cmyes11305Shave skin lesion 0.5 cm/ yes11306Shave skin lesion 0.6-1.0 cmyes11307Shave skin lesion 1.1-2.0 cmyes11308Shave skin lesion 2.0 cmyes11310Shave skin lesion 0.5 cm/ yes11311Shave skin lesion 0.6-1.0 cmyes11312Shave skin lesion 1.1-2.0 cmyes11313Shave skin lesion 2.0 cmyes11400Exc tr-ext b9 marg 0.5 cm yes11401Exc tr-ext b9 marg 0.6-1 cmyes11402Exc tr-ext b9 marg 1.1-2 cmyesyes11403Exc tr-ext b9 marg 2.1-3cm/ 11404Exc tr-ext b9 marg 3.1-4 cmyes11406Exc tr-ext b9 marg 4.0 cmyesyes11420Exc h-f-nk-sp b9 marg 0.5/ 11421Exc h-f-nk-sp b9 marg 0.6-1yes11422Exc h-f-nk-sp b9 marg 1.1-2yesExc h-f-nk-sp b9 marg 2.1-3yes1142311424Exc h-f-nk-sp b9 marg 3.1-4yes11426Exc h-f-nk-sp b9 marg 4 cmyes11440Exc face-mm b9 marg 0.5 cm/ yes11441Exc face-mm b9 marg 0.6-1 cmyes11442Exc face-mm b9 marg 1.1-2 cmyes11443Exc face-mm b9 marg 2.1-3 cmyes2016 Q4 Medicare CPT HCPCS2016 Medicare CPT HCPC List.xlsx11 of 160
Medicare Risk Adjustment Model CPT/HCPCS Filtering Included List,Calendar Year (CY) 2016, Quarter 4 (October)CPT only copyright 2016 American Medical Association. All rightsreserved.In CY2016 Q4HCPCS/CPT CodeShort DescriptionIncluded List?11444Exc face-mm b9 marg 3.1-4 cmyes11446Exc face-mm b9 marg 4 cmyes11450Removal sweat gland lesionyes11451Removal sweat gland lesionyes11462Removal sweat gland lesionyes11463Removal sweat gland lesionyes11470Removal sweat gland lesionyes11471Removal sweat gland lesionyesyes11600Exc tr-ext mal marg 0.5 cm/ 11601Exc tr-ext mal marg 0.6-1 cmyes11602Exc tr-ext mal marg 1.1-2 cmyes11603Exc tr-ext mal marg 2.1-3 cmyes11604Exc tr-ext mal marg 3.1-4 cmyes11606Exc tr-ext mal marg 4 cmyes11620Exc h-f-nk-sp mal marg 0.5/ yes11621Exc s/n/h/f/g mal mrg 0.6-1yes11622Exc s/n/h/f/g mal mrg 1.1-2yes11623Exc s/n/h/f/g mal mrg 2.1-3yes11624Exc s/n/h/f/g mal mrg 3.1-4yes11626Exc s/n/h/f/g mal mrg 4 cmyes11640Exc f/e/e/n/l mal mrg 0.5cm yes11641Exc f/e/e/n/l mal mrg 0.6-1yes11642Exc f/e/e/n/l mal mrg 1.1-2yes11643Exc f/e/e/n/l mal mrg 2.1-3yes11644Exc f/e/e/n/l mal mrg 3.1-4yes11646Exc f/e/e/n/l mal mrg 4 cmyes11719Trim nail(s) any numberyesyes11720Debride nail 1-511721Debride nail 6 or moreyes11730Removal of nail plateyesyes11740Drain blood from under nail11750Removal of nail bedyes11752Remove nail bed/tipyesRepair of nail bedyes1176011762Reconstruction of nail bedyes11765Excision of nail fold toeyes11770Remove pilonidal cyst simpleyes11771Remove pilonidal cyst extenyes11772Remove pilonidal cyst complyes11900Inject skin lesions /w 7yes2016 Q4 Medicare CPT HCPCS2016 Medicare CPT HCPC List.xlsx12 of 160
Medicare Risk Adjustment Model CPT/HCPCS Filtering Included List,Calendar Year (CY) 2016, Quarter 4 (October)CPT only copyright 2016 American Medical Association. All rightsreserved.In CY2016 Q4HCPCS/CPT CodeShort DescriptionIncluded List?11901Inject skin lesions 7yes11920Correct skin color 6.0 cm/ yes11921Correct skn color 6.1-20.0cmyes11950Tx contour defects 1 cc/ yes11951Tx contour defects 1.1-5.0ccyes11952Tx contour defects 5.1-10ccyes11954Tx contour defects 10.0 ccyes11960Insert tissue expander(s)yesyes11970Replace tissue expander11971Remove tissue expander(s)yes11976Remove contraceptive capsuleyes11980Implant hormone pellet(s)yes11981Insert drug implant deviceyes11982Remove drug implant deviceyes11983Remove/insert drug implantyes12001Rpr s/n/ax/gen/trnk 2.5cm/ yes12002Rpr s/n/ax/gen/trnk2.6-7.5cmyes12004Rpr s/n/ax/gen/trk7.6-12.5cmyes12005Rpr s/n/a/gen/trk12.6-20.0cmyes12006Rpr s/n/a/gen/trk20.1-30.0cmyes12007Rpr s/n/ax/gen/trnk 30.0 cmyes12011Rpr f/e/e/n/l/m 2.5 cm/ yes12013Rpr f/e/e/n/l/m 2.6-5.0 cmyes12014Rpr f/e/e/n/l/m 5.1-7.5 cmyes12015Rpr f/e/e/n/l/m 7.6-12.5 cmyes12016Rpr fe/e/en/l/m 12.6-20.0 cmyes12017Rpr fe/e/en/l/m 20.1-30.0 cmyesyes12018Rpr f/e/e/n/l/m 30.0 cm12020Closure of split woundyes12021Closure of split woundyesyes12031Intmd rpr s/a/t/ext 2.5 cm/ 12032Intmd rpr s/a/t/ext 2.6-7.5yes12034Intmd rpr s/tr/ext 7.6-12.5yesIntmd rpr s/a/t/ext 12.6-20yes1203512036Intmd rpr s/a/t/ext 20.1-30yes12037Intmd rpr s/tr/ext 30.0 cmyes12041Intmd rpr n-hf/genit 2.5cm/ yes12042Intmd rpr n-hf/genit2.6-7.5yes12044Intmd rpr n-hf/genit7.6-12.5yes12045Intmd rpr n-hf/genit12.6-20yes2016 Q4 Medicare CPT HCPCS2016 Medicare CPT HCPC List.xlsx13 of 160
Medicare Risk Adjustment Model CPT/HCPCS Filtering Included List,Calendar Year (CY) 2016, Quarter 4 (October)CPT only copyright 2016 American Medical Association. All rightsreserved.In CY2016 Q4HCPCS/CPT CodeShort DescriptionIncluded List?12046Intmd rpr n-hf/genit20.1-30yes12047Intmd rpr n-hf/genit 30.0cmyes12051Intmd rpr face/mm 2.5 cm/ yes12052Intmd rpr face/mm 2.6-5.0 cmyes12053Intmd rpr face/mm 5.1-7.5 cmyes12054Intmd rpr face/mm 7.6-12.5cmyes12055Intmd rpr face/mm 12.6-20 cmyes12056Intmd rpr face/mm 20.1-30.0yesyes12057Intmd rpr face/mm 30.0 cm13100Cmplx rpr trunk 1.1-2.5 cmyes13101Cmplx rpr trunk 2.6-7.5 cmyes13120Cmplx rpr s/a/l 1.1-2.5 cmyes13121Cmplx rpr s/a/l 2.6-7.5 cmyes13131Cmplx rpr f/c/c/m/n/ax/g/h/fyes13132Cmplx rpr f/c/c/m/n/ax/g/h/fyes13151Cmplx rpr e/n/e/l 1.1-2.5 cmyes13152Cmplx rpr e/n/e/l 2.6-7.5 cmyes13160Late closure of woundyes14000Tis trnfr trunk 10 sq cm/ yes14001Tis trnfr trunk 10.1-30sqcmyes14020Tis trnfr s/a/l 10 sq cm/ yes14021Tis trnfr s/a/l 10.1-30 sqcmyes14040Tis trnfr f/c/c/m/n/a/g/h/fyes14041Tis trnfr f/c/c/m/n/a/g/h/fyes14060Tis trnfr e/n/e/l 10 sq cm/ yes14061Tis trnfr e/n/e/l10.1-30sqcmyes14301Tis trnfr any 30.1-60 sq cmyesyes14350Filleted finger/toe flap15002Wound prep trk/arm/legyes15004Wound prep f/n/hf/gyesyes15040Harvest cultured skin graft15050Skin pinch graftyes15100Skin splt grft trnk/arm/legyesEpidrm autogrft trnk/arm/legyes1511015115Epidrm a-grft face/nck/hf/gyes15120Skn splt a-grft fac/nck/hf/gyes15130Derm autograft trnk/arm/legyes15135Derm autograft face/nck/hf/gyes15150Cult skin grft t/arm/legyes15155Cult skin graft f/n/hf/gyes2016 Q4 Medicare CPT HCPCS2016 Medicare CPT HCPC List.xlsx14 of 160
Medicare Risk Adjustment Model CPT/HCPCS Filtering Included List,Calendar Year (CY) 2016, Quarter 4 (October)CPT only copyright 2016 American Medical Association. All rightsreserved.In CY2016 Q4HCPCS/CPT CodeShort DescriptionIncluded List?15200Skin full graft trunkyes15220Skin full graft sclp/arm/legyes15240Skin full grft face/genit/hfyes15260Skin full graft een & lipsyes15271Skin sub graft trnk/arm/legyes15273Skin sub grft t/arm/lg childyes15275Skin sub graft face/nk/hf/gyes15277Skn sub grft f/n/hf/g childyesyes15570Skin pedicle flap trunk15572Skin pedicle flap arms/legsyes15574Pedcle fh/ch/ch/m/n/ax/g/h/fyes15576Pedicle e/n/e/l/ntroralyes15600Delay flap trunkyes15610Delay flap arms/legsyes15620Delay flap f/c/c/n/ax/g/h/fyes15630Delay flap eye/nos/ear/lipyes15650Transfer skin pedicle flapyes15731Forehead flap w/vasc pedicleyes15732Muscle-skin graft head/neckyes15734Muscle-skin graft trunkyes15736Muscle-skin graft armyes15738Muscle-skin graft legyes15740Island pedicle flap graftyes15750Neurovascular pedicle flapyes15756Free myo/skin flap microvascyes15757Free skin flap microvascyes15758Free fascial flap microvascyesyes15760Composite skin graft15770Derma-fat-fascia graftyes15775Hair trnspl 1-15 punch grftsyesyes15776Hair trnspl 15 punch grafts15780Dermabrasion total faceyes15781Dermabrasion segmental faceyesDermabrasion other than faceyes1578215783Dermabrasion suprfl any siteyes15786Abrasion lesion singleyes15788Chemical peel face epidermyes15789Chemical peel face dermalyes15792Chemical peel nonfacialyes15793Chemical peel nonfacialyes2016 Q4 Medicare CPT HCPCS2016 Medicare CPT HCPC List.xlsx15 of 160
Medicare Risk Adjustment Model CPT/HCPCS Filtering Included List,Calendar Year (CY) 2016, Quarter 4 (October)CPT only copyright 2016 American Medical Association. All rightsreserved.In CY2016 Q4HCPCS/CPT CodeShort DescriptionIncluded List?15819Plastic surgery neckyes15820Revision of lower eyelidyes15821Revision of lower eyelidyes15822Revision of upper eyelidyes15823Revision of upper eyelidyes15824Removal of forehead wrinklesyes15825Removal of neck wrinklesyes15826Removal of brow wrinklesyesyes15828Removal of face wrinkles15829Removal of skin wrinklesyes15830Exc skin abdyes15832Excise excessive skin thighyes15833Excise excessive skin legyes15834Excise excessive skin hipyes15835Excise excessive skin buttckyes15836Excise excessive skin armyes15837Excise excess skin arm/handyes15838Excise excess skin fat padyes15839Excise excess skin & tissueyes15840Nerve palsy fascial graftyes15841Nerve palsy muscle graftyes15842Nerve palsy microsurg graftyes15845Skin and muscle repair faceyes15850Remove sutures same surgeonyes15851Remove sutures diff surgeonyes15852Dressing change not for burnyes15860Test for blood flow in graftyesyes15876Suction lipectomy head&neck15877Suction lipectomy trunkyes15878Suction lipectomy upr extremyesyes15879Suction lipectomy lwr extrem15920Removal of tail bone ulceryes15922Removal of tail bone ulceryesRemove sacrum pressure soreyes1593115933Remove sacrum pressure soreyes15934Remove sacrum pressure soreyes15935Remove sacrum pressure soreyes15936Remove sacrum pressure soreyes15937Remove sacrum pressure soreyes15940Remove hip pressure soreyes2016 Q4 Medicare CPT HCPCS2016 Medicare CPT HCPC List.xlsx16 of 160
Medicare Risk Adjustment Model CPT/HCPCS Filtering Included List,Calendar Year (CY) 2016, Quarter 4 (October)CPT only copyright 2016 American Medical Association. All rightsreserved.In CY2016 Q4HCPCS/CPT CodeShort DescriptionIncluded List?15941Remove hip pressure soreyes15944Remove hip pressure soreyes15945Remove hip pressure soreyes15946Remove hip pressure soreyes15950Remove thigh pressure soreyes15951Remove thigh pressure soreyes15952Remove thigh pressure soreyes15953Remove thigh pressure soreyesyes15956Remove thigh pressure sore15958Remove thigh pressure soreyes15999Removal of pressure soreyes16000Initial treatment of burn(s)yes16020Dress/debrid p-thick burn syes16025Dress/debrid p-thick burn myes16030Dress/debrid p-thick burn lyes16035Incision of burn scab initiyes17000Destruct premalg lesionyes17004Destroy premal lesions 15/ yes17106Destruction of skin lesionsyes17107Destruction of skin lesionsyes17108Destruction of skin lesionsyes17110Destruct b9 lesion 1-14yes17111Destruct lesion 15 or moreyes17250Chemical cautery tissueyes17260Destruction of skin lesionsyes17261Destruction of skin lesionsyes17262Destruction of skin lesionsyesyes17263Destruction of skin lesions17264Destruction of skin lesionsyes17266Destruction of skin lesionsyesyes17270Destruction of skin lesions17271Destruction of skin lesionsyes17272Destruction of skin lesionsyesDestruction of skin lesionsyes1727317274Destruction of skin lesionsyes17276Destruction of skin lesionsyes17280Destruction of skin lesionsyes17281Destruction of skin lesionsyes17282Destruction of skin lesionsyes17283Destruction of skin lesionsyes2016 Q4 Medicare CPT HCPCS2016 Medicare CPT HCPC List.xlsx17 of 160
Medicare Risk Adjustment Model CPT/HCPCS Filtering Included List,Calendar Year (CY) 2016, Quarter 4 (October)CPT only copyright 2016 American Medical Association. All rightsreserved.In CY2016 Q4HCPCS/CPT CodeShort DescriptionIncluded List?17284Destruction of skin lesionsyes17286Destruction of skin lesionsyes17311Mohs 1 stage h/n/hf/gyes17313Mohs 1 stage t/a/lyes17340Cryotherapy of skinyes17360Skin peel therapyyes17380Hair removal by electrolysisyes17999Skin tissue procedureyesyes19000Drainage of breast lesion19020Incision of breast lesionyes19105Cryosurg ablate fa eachyes19110Nipple explorationyes19112Excise breast duct fistulayes19120Removal of breast lesionyes19125Excision breast lesionyes19260Removal of chest wall lesionyes19271Revision of chest wallyes19272Extensive chest wall surgeryyes19296Place po breast cath for radyes19298Place breast rad tube/cathsyes19300Removal of breast tissueyes19301Partial mastectomyyes19302P-mastectomy w/ln removalyes19303Mast simple completeyes19304Mast subqyes19305Mast radicalyes19306Mast rad urban typeyesyes19307Mast mod rad19316Suspension of breastyes19318Reduction of large breastyesyes19324Enlarge breast19325Enlarge breast with implantyes19328Removal of breast implantyesRemoval of implant materialyes1933019340Immediate breast prosthesisyes19342Delayed breast prosthesisyes19350Breast reconstructionyes19355Correct inverted nipple(s)yes19357Breast reconstructionyes19361Breast reconstr w/lat flapyes2016 Q4 Medicare CPT HCPCS2016 Medicare CPT HCPC List.xlsx18 of 160
Medicare Risk Adjustment Model CPT/HCPCS Filtering Included List,Calendar Year (CY) 2016, Quarter 4 (October)CPT only copyright 2016 American Medical Association. All rightsreserved.In CY2016 Q4HCPCS/CPT CodeShort DescriptionIncluded List?19364Breast reconstructionyes19366Breast reconstructionyes19367Breast reconstructionyes19368Breast reconstructionyes19369Breast reconstructionyes19370Surgery of breast capsuleyes19371Removal of breast capsuleyes19380Revise breast reconstructionyesyes19396Design custom breast implant19499Breast surgery procedureyes20005I&d abscess subfascialyes20100Explore wound
HCPCS/CPT Code. Short Description: In CY2016 Q4 Included List? C5271 Low cost skin substitute app yes C5273 Low cost skin substitute app yes . 2016 Q4 Medicare CPT HCPCS 2016 Medicare CPT HCPC List.xlsx 6 of 160. HCPCS/CPT Code. Short Description. In CY2016 Q4 Included List?
