Code|Code Description|Aetna|Cigna HMO|United Health Care |Humana|Anthem Blue Cross HMO|
10005|Fine needle aspiration of first lesion using ultrasound guidance|3018|1908|3512|3625|3637.18|||||
10060|Drainage of abscess|3018|1908|2302|2067|3637.18|||||
10160|Aspiration of abscess, blood accumulation, blister, or cyst|3018|1908|2302|2067|3637.18|||||
12013|Repair of wound (2.6 to 5.0 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes|4506|1908|2302|2067|3637.18|||||
19120|Removal of 1 or more breast growth, open procedure|5170|3131|5338|3392|6344.23|||||
20610|Aspiration and/or injection of large joint or joint capsule|3018|1908|2302|2067|3637.18|||||
23350|Injection of dye for X-ray imaging of shoulder joint|3018|1908|2302|2067|3637.18|||||
29826|Shaving of shoulder bone using an endoscope|5170|3131|2302|3392|6344.23|||||
29881|Removal of one knee cartilage using an endoscope|5686|3653|7298|4027|6696.54|||||
38222|Diagnostic aspirations and biopsies of bone marrow|3018|1908|4554|3625|3637.18|||||
42820|Removal of tonsils and adenoid glands patient younger than age 12|5170|3131|5338|3392|6344.23|||||
43235|Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope|3018|1908|4554|2067|3637.18|||||
43239|Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope|4195|2550|4554|2762|5246.29|||||
45378|Diagnostic examination of large bowel using an endoscope|4195|2550|4554|2762|5246.29|||||
45380|Biopsy of large bowel using an endoscope|4195|2550|4554|2762|5246.29|||||
45385|Removal of polyps or growths of large bowel using an endoscope|4195|2550|4554|2762|5246.29|||||
45391|Ultrasound examination of lower large bowel using an endoscope|4195|2550|4554|2762|5246.29|||||
49505|Repair of groin hernia patient age 5 years or older|5686|3653|7298|4027|6696.54|||||
55700|Biopsy of prostate gland|4195|2550|4554|2762|5246.29|||||
59400|Obstetrical pre‐ and postpartum care and vaginal delivery|4425|3956.9|3817.5|3792|3731.56|||||
59510|Cesarian delivery with pre- and post‐delivery care|4613|4392.6|4312.46|3792|4018.61|||||
59610|Vaginal delivery after prior cesarean delivery|4509|4165.57|3994.78|3792|3731.56|||||
62270|Spinal tap for diagnosis|3018|1908|3512|1946|3637.18|||||
62322|Injection of substance into spinal canal of lower back or sacrum|3018|1908|3512|3625|3637.18|||||
62323|Injection of substance into spinal canal of lower back or sacrum using imaging guidance|3018|1908|3512|3625|3637.18|||||
64483|Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root, single level|3018|1908|3512|2067|3637.18|||||
64490|Injections of upper or middle spine facet joint using imaging guidance, single level|3018|1908|3512|3625|3637.18|||||
64493|Injections of lower or sacral spine facet joint using imaging guidance, single level|3018|1908|3512|3625|3637.18|||||
64635|Destruction of lower or sacral spinal facet joint nerves using imaging guidance|3018|4228|5338|3625|5470.6536|||||
66821|Removal of recurring cataract in lens capsule using laser|4195|2550|3512|2762|5246.29|||||
66984|Removal of cataract with insertion of lens|8760|5977|5338|6472|9189.64|||||
70150|X-ray of bones of face, minimum of 3 views|127.8|58.67|111.13|111.13|111.13|||||
70160|X-ray of bones of nose, minimum of 3 views|106.95|49.64|93|93|93|||||
70220|X-ray of paranasal sinus, complete, minimum of 3 views|113.87|45.77|99.02|99.02|99.02|||||
70250|X-ray of skull, less than 4 views|106.95|45.77|93|93|93||||137.725|
70355|Orthopantogram (e.g., panoramic x-ray)|42.99|15.47|37.38|37.38|37.38|||||
70360|X-ray of soft tissue of neck|83.32|38.68|72.45|72.45|72.45|||||
70450|CT scan head or brain|492|131.52|484|473|400|||||
70460|CT scan head or brain with contrast|492|192.77|484|473|400|||||
70470|CT scan head or brain before and after contrast|492|230.81|484|473|400|||||
70480|CT scan of cranial cavity|492|246.92|484|473|400|||||
70481|CT scan of cranial cavity with contrast|492|302.37|484|473|400|||||RAD FS found on Mnaged cares shared drive
70486|CT scan of face|492|174.07|484|473|400|||||
70487|CT scan of face with contrast|492|199.86|484|473|400|||||
70490|CT scan of neck|492|181.16|484|473|400|||||
70491|CT scan of neck with contrast|492|241.12|484|473|400|||||
70496|CT scan of blood vessel of head with contrast|492|378.44|484|473|400|||||
70498|CT scan of neck blood vessels with contrast|492|377.8|484|473|400|||||
70543|MRI scan bones of the eye, face, and/or neck before and after contrast|741|511.25|727|723|600|||||
70544|MRA scan of head blood vessels|741|335.25|727|723|600|||||
70547|MRA scan of neck blood vessels|741|336.54|727|723|600|||||
70549|MRA scan of neck blood vessels before and after contrast|741|542.2|727|723|600|||||
70551|MRI scan brain|741|268.84|727|723|600|||||
70552|MRI scan of brain with contrast|741|397.14|727|723|600|||||
70553|MRI scan of brain before and after contrast|741|452.59|727|723|600|||||
71045|X-ray of chest, 1 view|43.47|29.66|37.8|53.1|45.33|453.6|53.095|||
71046|X-ray of chest, 2 views|79.58|39.33|69.2|72.42|69.2|527.8|72.415|||
71047|X-ray of chest, 3 views|101.27|49.64|88.06|89.36|88.06|568.4|89.355|||
71048|X-ray of chest, minimum of 4 views|104.13|51.58|90.55|114.73|90.58|692.3|114.73|||
71100|X-ray of ribs of one side of body, 2 views|91.66|43.84|79.7|79.7|79.7|||||
71101|X-ray of ribs on one side of body including the chest, minimum of 3 views|112.5|49.64|97.83|97.83|97.83|||||
71111|X-ray of both sides of the ribs including the chest, minimum of 4 views|159.76|63.18|138.92|138.92|138.92|||||
71250|CT scan chest|492|181.16|484|473|400|||||
71260|CT scan chest with contrast|492|241.77|484|473|400|||||
71270|CT scan chest before and after contrast|492|295.28|484|473|400|||||
71275|CT scan of blood vessels in chest with contrast|492|383.6|484|473|400|||||
72020|X-ray of spine, 1 view|68.02|29.01|59.15|59.15|59.15|||||
72040|X-ray of spine of neck, 2 or 3 views|102.76|48.35|89.36|89.36|89.36|||||
72050|X-ray of upper spine, 4 or 5 views|138.91|66.4|120.79|120.79|120.79|||||
72070|X-ray of middle spine, 2 views|97.21|38.68|84.53|84.53|84.53|||||
72072|X-ray of middle spine, 3 views|112.5|48.35|97.83|97.83|97.83|||||
72080|X-ray of middle and lower spine, 2 views|106.95|41.9|93|92.96|93|||||
72081|X-ray of spine, entire middle and lower spine, 1 view|102.8|50.93|89.39|100.24|89.6|490|137.725|||
72082|X-ray of spine, entire middle and lower spine, 2 or 3 views|186.89|92.84|162.51|137.73|162.4|612.5|209.02|||
72100|X-ray of lower and sacral spine, 2 or 3 views|44.64|48.35|38.82|38.81|38.82|||||
72110|X‐ray of lower and sacral spine, minimum of 4 views|60.72|63.83|52.8|52.8|52.8|||||
72120|X-ray lower and sacral spine including bending views 2 or 3 views|55.96|50.93|48.66|48.66|48.66|||||
72125|CT scan of upper spine|492|190.83|484|473|400|||||
72128|CT scan of middle spine|492|190.83|484|473|400|||||
72131|CT scan of lower spine|492|189.54|484|473|400|||||
72132|CT scan of lower spine with contrast|492|243.7|484|473|400|||||Example of CPT 55700 listed on both groupers ASC 2 and default grouper - Vanessa advised to use numerical grouper which is consistant with XR in Epic
72141|MRI scan of upper spinal canal|741|257.88|727|723|600|||||
72146|MRI scan of middle spinal canal|741|257.88|727|723|600|||||
72148|MRI scan of lower spinal canal|741|258.53|727|723|600|||||
72156|MRI scan of upper spinal canal before and after contrast|741|457.74|727|723|600|||||
72157|MRI scan of middle spinal canal before and after contrast|741|459.03|727|723|600|||||
72158|MRI scan of lower spinal canal before and after contrast|741|456.45|727|723|600|||||
72170|X-ray of pelvis, 1 or 2 views|84.69|35.46|73.64|73.64|73.64|||||
72190|X-ray of pelvis, minimum of 3 views|137.54|50.29|119.6|119.56|119.6|||||
72192|CT scan pelvis|492|164.4|484|473|400|||||
72193|CT scan pelvis with contrast|492|333.31|484|473|400|||||
72195|MRI scan of pelvis|741|348.79|727|723|600|||||
72197|MRI scan of pelvis before and after contrast|741|508.68|727|723|600|||||
72202|X-ray of sacroiliac joints, 3 or more views|108.32|47.71|94.19|94.19|94.19|||||
72220|X-ray of pelvis, minimum of 2 views|87.47|40.62|76.06|76.06|76.06|||||
73000|X-ray of collar bone|88.87|41.26|77.28|77.28|77.28|||||
73020|X-ray of shoulder, 1 view|69.39|24.5|60.34|60.34|60.34|||||
73030|X-ray of shoulder, minimum of 2 views|90.24|42.55|78.47|78.47|78.47|||||
73060|X-ray of upper arm, minimum of 2 views|87.47|41.26|76.06|76.06|76.06|||||
73070|X-ray of elbow, 2 views|88.87|36.1|77.28|77.28|77.28|||||
73080|X-ray of elbow, minimum of 3 views|106.95|39.97|93|92.96|93|||||
73090|X-ray of forearm, 2 views|84.69|36.75|73.64|73.68|73.64|||||
73100|X-ray of wrist, 2 views|98.61|43.84|85.75|85.72|85.75|||||
73110|X-ray of wrist, minimum of 3 views|125.02|54.15|108.71|108.68|108.71|||||
73120|X-ray of hand, 2 views|83.32|39.33|72.45|72.45|72.45|||||
73130|X-ray of hand, minimum of 3 views|102.76|47.06|89.36|89.36|89.36|||||
73140|X-ray of fingers, minimum of 2 views|115.28|51.58|100.24|100.24|100.24|||||
73200|CT scan of arm|492|232.74|484|473|400|||||
73201|Computed tomography, upper extremity; with contrast material(s)|381.21|297.86|484|473|400|||||
73218|MRI scan of arm|741|516.41|727|723|600|||||
73221|MRI scan of arm joint|741|291.41|727|723|600|||||
73222|MRI scan of arm joint with contrast|741|513.83|727|723|600|||||
73501|X-ray of hip with pelvis, 1 view|82.51|39.97|71.75|67.59|71.75|||||
73502|X-ray of hip with pelvis, 2-3 views|121.64|61.25|105.77|105.07|105.77|||||
73521|Radiologic examination, hips, bilateral, with pelvis when performed; 2 views|114.39|51.58|99.47|102.66|98.18|||||
73552|X-ray of femur, minimum 2 views|92.66|45.77|80.57|72.45|80.57|||||
73560|X-ray of knee, 1 or 2 views|93.02|45.13|80.89|80.89|80.89|||||
73562|X-ray of knee, 3 views|119.46|53.51|103.88|103.85|103.88|||||
73564|X-ray of knee, 4 or more views|137.54|58.67|119.6|119.6|119.6|||||
73590|X-ray of lower leg, 2 views|81.91|40.62|71.23|71.23|71.23|||||
73600|X-ray of ankle, 2 views|88.87|41.9|77.28|77.28|77.28|||||
73610|X-ray of ankle, minimum of 3 views|106.95|47.06|93|92.97|93|||||
73620|X-ray of foot, 2 views|36.9|36.1|32.09|32.09|32.09|||||
73630|X-ray of foot, minimum of 3 views|42.85|43.84|37.26|37.26|37.26|||||
73650|X-ray of heel, minimum of 2 views|88.87|36.1|77.28|77.28|77.28|||||
73660|X-ray of toes, minimum of 2 views|102.76|38.68|89.36|89.36|89.36|||||
73700|CT scan leg|492|189.54|484|473|400|||||
73701|CT scan leg with contrast injection|492|245.63|484|473|400|||||
73706|CT scan of lower leg blood vessels with contrast|492|473.21|484|473|400|||||
73718|MRI scan of leg|741|344.27|727|723|600||||Example where Humana allowed 70% of charge |
73721|MRI scan of leg joint|741|291.41|727|723|600||||10006143252|
74018|X-ray of abdomen, 1 view|73.82|36.1|64.19|56.7|64.19|||||
74019|X-ray of abdomen, 2 views|88.27|43.84|76.76|99.02|76.76|||||
74021|X-ray of abdomen, minimum of 3 views|102.72|50.93|89.32|99.02|89.32|||||
74150|CT scan abdomen|492|161.82|484|473|400|||||
74160|CT scan abdomen with contrast|492|332.03|484|473|400|||||
74170|CT scan abdomen before and after contrast|492|377.8|484|473|400|||||
74174|CT scan of abdominal and pelvic blood vessels with contrast|492|535.11|484|473|400|||||
74176|CT scan of abdomen and pelvis|492|203.73|484|473|400|||||
74177|CT scan of abdomen and pelvis with contrast|492|426.8|484|473|400|||||
74178|CT scan of abdomen and pelvis before and after contrast|492|484.18|484|473|400|||||
74181|MRI scan of abdomen|741|274.65|727|723|600|||||
74183|MRI scan of abdomen before and after contrast|741|509.96|727|723|600|||||
74230|Imaging for evaluation of swallowing function|492|183.29|240.45|240.45|240.45|||||
74240|X-ray of upper digestive tract with single contrast|340.43|140.84|296.03|296.07|296.03|||||
74246|X-ray of upper digestive tract with double contrast|402.98|166.57|350.42|350.07|350.42|||||
74250|X-ray of upper digestive tract with single contrast and multiple serial films|362.7|144.7|315.39|315.39|315.39|||||
74300|Radiological supervision and interpretation X-ray of bile and/or pancreatic ducts during surgery|134.4|962.14|116.87|82.01|116.87|||||
75561|MRI of heart before and after contrast|741|529.31|727|723|600|||||
75571|CT scan of heart with evaluation of blood vessel calcium|492|137.32|484|473|400|||||
75572|CT scan of heart structure with contrast|492|293.34|484|473|400|||||
75574|CT scan of heart blood vessels and grafts with contrast dye|492|437.11|484|473|400|||||
75710|Radiological supervision and interpretation of imaging of artery of one arm or leg|526.71|191.66|458.01|458.01|458.01|||||
76010|Imaging from nose to rectum, single view, child|76.36|35.46|66.4|66.4|66.4|||||
76506|Ultrasound of brain|397.43|150.86|345.59|345.59|345.59|||||
76536|Ultrasound of head and neck|398.84|159.24|346.82|346.82|346.82|||||
76604|Ultrasound of chest|258.45|90.9|224.74|224.74|224.74|||||
76641|Ultrasound of one breast, complete|290.61|128.3|252.7|369.74|252.7|||||
76642|Ultrasound of one breast, limited|222.66|97.35|193.62|369.74|193.62|||||
76700|Ultrasound of abdomen|182.25|148.93|158.48|158.46|158.48|||||
76705|Ultrasound of abdomen, limited|143.52|112.18|124.8|124.82|124.8|||||
76770|Ultrasound behind abdominal cavity|405.77|138.61|352.84|352.87|352.84|||||
76775|Ultrasound behind abdominal cavity, limited|339.07|54.15|294.84|294.84|294.84|||||
76801|Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus|141.75|131.52|123.26|123.24|123.26|||||
76805|Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or|179.26|163.76|155.88|155.9|155.88|||||
76815|Ultrasound of pregnant uterus, 1 or more fetus(es)|106.59|93.48|92.69|92.69|92.69|||||
76817|Vaginal ultrasound of pregnant uterus|117.91|105.73|102.53|102.53|102.53|||||
76818|Fetal biophysical profile; with non-stress testing|302.92|119.27|263.41|263.41|263.41|||||
76830|Ultrasound pelvis through vagina|74.42|160.53|64.71|64.71|64.71|||||
76856|Ultrasound of pelvis, complete, not pregnancy related|164.38|136.68|142.94|142.94|142.94|||||
76857|Ultrasound of pelvis, limited, not pregnancy related|137.57|43.19|119.63|119.63|119.63|||||
76870|Ultrasound of scrotum|391.87|132.81|340.76|340.76|340.76|||||
76882|Partial ultrasound of joint or other non-blood vessel structure of arm or leg|47.17|59.31|41.02|41.03|41.02|||||
76885|Ultrasound of hips with manipulation, infant|475.27|193.41|413.28|413.28|413.28|||||
77065|Diagnostic mammography of one breast|109.49|168.91|95.21|196.95|95.86|||||
77066|Diagnostic mammography of both breasts|140.06|215.33|121.79|259.37|122.42|||||
77072|Imaging for bone age assessment|59.7|28.37|51.91|51.87|51.91|||||
77075|X-ray survey of forearm or wrist bone density|334.88|108.69|291.2|291.24|291.2|||||
77077|Imaging of 2 or more joints, single view|101.4|51.58|88.17|88.17|88.17|||||
77081|Bone density measurement of the core or extremities (e.g., radius, wrist, heel)|72.17|39.97|62.76|62.79|62.76|||||
78452|Nuclear medicine study of vessels of heart using drugs or exercise multiple studies|1738.48|721.42|1511.72|1511.72|1511.72|||||
80048|Blood test, basic group of blood chemicals (Calcium, total)|13.5|16.76|14.83|11.63|CO|||||
80053|Blood test, comprehensive group of blood chemicals|17.08|21.28|18.53|14.53|CO|||||
80061|Blood test, lipids (cholesterol and triglycerides)|27.8|26.43|23.48|18.42|CO|||||
80069|Kidney function blood test panel|13.9|17.41|15.22|11.94|CO|||||
80076|Liver function blood test panel|13.11|16.12|14.32|11.23|CO|||||
80170|Gentamycin|26.21|32.24|28.72|22.53|CO|||||
80178|Lithium|10.72|12.89|11.58|9.09|CO|||||
80185|Dilantin|21.45|26.43|23.23|18.22|CO|||||
81000|Manual urinalysis test with examination using microscope, non-automated|5.16|7.09|5.56|4.35|CO|||||
81001|Urinalysis auto w/microscope|5.16|6.45|5.56|4.35|CO|||||
81002|Urinalysis, manual test|3.97|6.45|4.49|3.52|CO|||||
81003|Automated urinalysis test|3.58|4.51|3.94|3.09|CO|||||
81025|Urine pregnancy test, by visual color comparison methods|10.33|15.47|11.09|8.7|CO|||||
82043|Albumin; urine (e.g., microalbumin), quantitative|9.13|11.6|10.14|7.95|CO|||||
82105|Alpha-fetoprotein (AFP); serum|27|33.53|29.39|23.06|CO|||||
82232|Beta-2 microglobulin|25.82|32.24|28.34|22.24|CO|||||
82306|Vitamin D|47.66|58.67|51.86|40.7|CO|||||
82310|Calcium|8.34|10.32|9.04|7.09|CO|||||
82436|Cloride urine|7.95|10.32|8.81|6.91|CO|||||
82570|Creatinine urine|8.34|10.32|9.07|7.11|CO|||||
82607|B12|24.23|29.66|26.41|20.72|CO|||||
82652|Vitamin D; 1, 25 dihydroxy, includes fraction(s), if performed|61.95|76.72|67.44|52.92|CO|||||
82668|Erythopoietin|30.19|37.39|32.94|25.84|CO|||||
82677|Estriol|38.92|47.71|42.37|33.25|CO|||||
82728|Ferritin|21.84|27.08|23.87|18.73|CO|||||
82731|Fetal fibronectin, cervicovaginal secretions, semi-quantitative|103.26|127.65|112.85|88.54|89.79|||||
82977|Glutamyltransferase, gamma (GGT)|11.51|14.18|12.61|9.9|CO|||||
83036|Hemoglobin; glycosylated (A1C)|15.49|19.34|17|13.34|CO|||||
83051|Hemoglobin; plasma|11.91|14.18|12.8|10.05|CO|||||
83540|Iron|10.33|12.89|11.35|8.9|CO|||||
83550|Iron binding capacity|13.9|17.41|15.32|12.02|CO|||||
83630|Lactoferrin, fecal; qualitative|31.37|38.68|34.39|26.98|CO|||||
83735|Magnesium|10.72|13.54|11.74|9.21|CO|||||
84133|Potassium; urine|6.75|8.38|7.54|5.91|CO|||||
84153|PSA (prostate specific antigen) measurement, total|29.38|36.75|32.22|25.29|CO|||||
84154|PSA (prostate specific antigen) measurement, free|29.38|36.75|32.22|25.29|CO|||||
84425|Thiamine (Vitamin B-1)|34.16|41.91|37.21|29.19|CO|||||
84439|Thyroxine; free|14.29|18.05|15.8|12.4|CO|||||
84443|Blood test, thyroid stimulating hormone (TSH)|27|33.53|29.44|23.1|CO|||||
84481|Triiodothyronine T3; free|27|33.53|29.69|23.29|CO|||||
84540|Urea nitrogen, urine|7.54|9.67|8.32|6.53|CO|||||
84702|Gonadotropin, chorionic (hCG); quantitative|24.23|29.66|26.38|8.82|CO|||||
85025|Complete blood cell count, automated test and automated differential white blood cell count|11.03|15.47|13.62|10.69|10.71|||||
85027|Complete blood cell count (red cells, white blood cell, platelets), automated test|10.33|12.89|11.34|8.89|8.98|||||
85300|Clotting inhibitors or anticoagulants; antithrombin III, activity|19.07|23.21|20.76|16.29|CO|||||
85610|Blood test, clotting time|6.36|7.74|6.89|5.4|5.53|||||
85652|Sedimentation rate, erythrocyte; automated|4.37|5.16|4.73|3.71|CO|||||
85730|Coagulation assessment blood test, plasma or whole blood|9.53|11.6|10.51|8.25|8.29|||||
86003|Allergen specific IgE; quantitative or semiquantitative, crude allergen extract, each|8.34|10.32|9.14|7.1|CO|||||
86140|C-reactive protein|8.34|10.32|9.07|7.11|7.25|||||
86146|Beta 2 Glycoprotein I antibody, each|40.91|50.29|44.57|34.97|CO|||||
86148|Anti-phosphatidylserine (phospholipid) antibody|25.82|31.59|28.14|22.08|CO|||||
86304|Immunoassay for tumor antigen, quantitative; CA 125|33.36|41.26|36.46|28.61|CO|||||
86308|Heterophile antibodies; screening|8.34|10.32|9.07|7.11|CO|||||
86735|Antibody; mumps|21.05|25.79|22.87|17.94|CO|||||
86765|Antibody; rubeola|20.65|25.79|22.57|17.71|CO|||||
86780|Antibody; Treponema pallidum|21.05|26.43|22.76|18.2|CO|||||
86787|Antibody; varicella-zoster|20.65|25.79|22.57|17.71|CO|||||
86803|Hepatitis C antibody|23.03|28.37|25.01|19.62|CO|||||
87046|Culture, bacterial; stool, aerobic, additional pathogens|15.09|18.7|16.52|12.97|CO|||||
87086|Culture, bacterial; quantitative colony count, urine|13.11|16.12|14.15|11.1|CO|||||
87324|Infectious agent antigen detection qualitative or semiquantitative; Clostridium difficile toxin(s)|19.07|23.85|21.02|16.49|CO|||||
87389|Infectious agent antigen detection HIV-1 antigen(s), with HIV-1 and HIV-2 antibodies, single result|38.53|47.71|40.94|33.11|CO|||||
87400|Infectious agent antigen detection by immunoassay technique Influenza, A or B, each|19.07|25.14|21.02|16.49|CO|||||
87491|Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, amplified probe technique|56.4|69.63|61.5|26.97|CO|||||
87591|Infectious agent detection by nucleic acid (DNA or RNA); Neisseria gonorrhoeae, amplified probe technique|56.4|69.63|61.5|26.97|CO|||||
88175|Pap test, automated thin layer preparation; automated system and manual rescreening|42.49|52.87|46.42|36.38|CO|||||
90832|Psychotherapy, 30 minutes|370.53|335.07|387|275.4|389.3634|||||
90834|Psychotherapy, 45 minutes|469.02|424.13|489|348.6|492.411|||||
90837|Psychotherapy, 60 minutes|913.82|826.36|954|679.2|960.0384|||||
90846|Family psychotherapy, 50 minutes|282.75|179.79|244.296|226.2|136.08|||||
90847|Family psychotherapy including patient, 50 minutes|370.34|320.47|311.69|263.4|313.58|||||
90853|Group psychotherapy|384.26|347.48|460.728|437.6|463.7142|||||
92507|Treatment of speech, language, voice, communication, and/or hearing processing disorder|429|282|395|213|403.54|||||
92521|Evaluation of speech fluency|429|282|395|213|403.54|||||
92523|Evaluation of speech sound production with evaluation of language comprehension and expression|429|282|395|213|403.54|||||
92526|Treatment of swallowing and/or oral feeding function|429|282|395|213|403.54|||||
92605|Evaluation and prescription of nonspeech-generating and alternative communication device, first hour|429|282|395|213|403.54|||||
92610|Evaluation of swallowing function|429|282|395|213|403.54|||||
92611|Fluoroscopic and video recorded motion evaluation of swallowing function|429|282|395|213|403.54|||||
93005|Routine electrocardiogram (EKG) with tracing using at least 12 leads|25.33|427.78|508|363.6|511.3248|||||
93015|Cardiac stress test with supervision and report|236.3|178.05|243.77|200.73|215.67|||||
93270|Heart rhythm symptom-related tracing of 24-hour EKG monitoring up to 30 days|26.25|88.33|105|75|80.8728|||||
93452|Insertion of catheter into left heart including imaging interpretation and supervision and injection|11517|9395|11168|13380|12474.5|||||
93458|Insertion of catheter in left heart for imaging of blood vessels and left lower heart |11517|9395|14352|13380|12474.5|||||
93798|Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session|275.25|205.86|238|169.2|201.43|||||
93923|Ultrasound study of arteries of both arms and legs, complete|398.02|200.5|611|435|442.3|||||
94625|Outpatient pulmonary rehabilitation, per session|194.25|69.93|177.16|155.4|74|||||
94626|Outpatient pulmonary rehabilitation with continuous monitoring of blood oxygen, per session|194.25|69.93|177.16|155.4|74|||||
94640|Respiratory inhaled treatment to relieve airway obstruction or for sputum specimen|412.78|282|395|213|491.7588|||||
95708|Measurement of brain wave activity (EEG), 12-26 hours, unmonitored|5545.57|4942.83|5866|4198.8|5904.3666|||||
95800|Study of sleep patterns, including sleep time|1234|801.54|903|631.2|686.1144|||||
95816|Measurement and recording of brain wave (EEG) activity, awake and drowsy|1656|1205.96|1431|1024.2|1440.0576|||||
95992|Canalith repositioning procedure(s) (e.g., Epley maneuver, Semont maneuver), per day|429|282|395|213|403.54|||||
97033|Application of medication through skin using electrical current, each 15 minutes|429|282|395|213|403.54|||||
97035|Application of ultrasound to 1 or more areas, each 15 minutes|429|282|395|213|403.54|||||
97110|Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes|429|282|395|213|403.54|||||
97112|Therapeutic procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes|429|282|395|213|403.54|||||
97113|Water pool therapy with therapeutic exercises to 1 or more areas, each 15 minutes|429|282|395|213|403.54|||||
97116|Walking training to 1 or more areas, each 15 minutes|429|282|395|213|403.54|||||
97129|Therapy procedure for a range of mental processes, initial 15 minutes|429|282|395|213|403.54|||||
97130|Therapy procedure for a range of mental processes, each additional 15 minutes|429|282|395|213|403.54|||||
97140|Manual (physical) therapy techniques to 1 or more regions, each 15 minutes|429|282|395|213|403.54|||||
97161|Evaluation of physical therapy, typically 20 minutes|429|282|395|213|403.54|||||
97162|Evaluation of physical therapy, typically 30 minutes|429|282|395|213|403.54|||||
97163|Evaluation of physical therapy, typically 45 minutes|429|282|395|213|403.54|||||
97164|Re-evaluation of physical therapy, typically 20 minutes|429|282|395|213|403.54|||||
97165|Evaluation of occupational therapy, typically 30 minutes|429|282|395|213|403.54|||||
97166|Evaluation of occupational therapy, typically 45 minutes|429|282|395|213|403.54|||||
97167|Evaluation of occupational therapy established plan of care, typically 60 minutes|429|282|395|213|403.54|||||
97168|Re-evaluation of occupational therapy established plan of care, typically 30 minutes|429|282|395|213|403.54|||||
97530|Therapeutic activities to improve function, per each 15 minutes|429|282|395|213|403.54|||||
97535|Self-care or home management training, each 15 minutes|429|282|395|213|403.54|||||
97606|Negative pressure wound therapy, surface area greater than 50 square centimeters, per session|429|282|454|323.4|385.0077|||||
97760|Training in use of orthotics (supports, braces, or splints) for arms, legs and/or trunk, per 15 minutes|429|282|395|213|403.54|||||
C8908|Magnetic resonance imaging without contrast followed by with contrast, breast; bilateral |741|652.88|727|723|600|||||
C8924|Transthoracic echocardiography with or without contrast, , follow-up or limited study|980.25|996.45|847|784.2|650.2434|||||
C8929|Transthoracic echocardiography with or without contrast,  complete, with doppler and with color flow|3297|1436.64|2849|2637.6|2867.0712|||||
C8930|Transthoracic echocardiography with or without contrast,  rest and stress, including cardiac monitoring|2391|2014.8|2066|1451.4|2079.2136|||||
G0283|Electrical stimulation (unattended), to one or more areas, other than wound care|429|282|395|213|403.54|||||
|||||||||||
Abbreviation Key|||||||||||
Acronym|Meaning||||||||||
CO|Carve-Out. Anthem only, non-covered lab only are covered through their national lab contracts||||||||||
CT|Computed Tomography||||||||||
DNA|Deoxyribonucleic Acid||||||||||
EEG|Electroencephalogram||||||||||
EKG|Electrocardiogram||||||||||
HCG|Human Chorionic Gonadotropin||||||||||
MRA|Magnetic Resonance Angiogram||||||||||
MRI|Magnetic Resonance Imaging||||||||||
RNA|Ribonucleic Acid||||||||||
TTE|Transthoracic echocardiography||||||||||