Updates Affecting OPPS Payments – Criteria for a CPT Code combination to receive a complexity adjustment due to the CPT combination representing a costly, complex service are as follows: • Frequency threshold of 25 or more claims with the CPT Code combination • Cost threshold where there is violation of the 2 times rule- comprehensive mean geometric cost of the CPT Code combination exceeds the comprehensive mean geometric cost of the lowest CPT Code assigned to the C-APC – Addendum J lists the CPT Code combinations that qualify for a complexity adjusted payment
Updates Affecting OPPS Payments
Updates Affecting OPPS Payments
Updates Affecting OPPS Payments Addendum J for CY2015 complexity adjustments of combinations of comprehensive HCPCS codes Secondary or Secondary Complexity Primary HCPCS Primary Primary APC Device Add-on Secondary APC Adjusted APC Code Primary Short Descriptor SI Assignment HCPCS Code Secondary Short Descriptor SI Assignment Assignment 61885 Insrt/redo neurostim 1 array J1 0039 61885 Insrt/redo neurostim 1 array J1 0039 0318 61885 Insrt/redo neurostim 1 array J1 0039 64553 Implant neuroelectrodes J1 0061 0318 61885 Insrt/redo neurostim 1 array J1 0039 64569 Revise/repl vagus n eltrd J1 0061 0318 64590 Insrt/redo pn/gastr stimul J1 0039 64555 Implant neuroelectrodes J1 0061 0318 64590 Insrt/redo pn/gastr stimul J1 0039 64575 Implant neuroelectrodes J1 0061 0318 64590 Insrt/redo pn/gastr stimul J1 0039 64590 Insrt/redo pn/gastr stimul J1 0039 0318 64555 Implant neuroelectrodes J1 0061 63650 Implant neuroelectrodes J1 0061 0039 64581 Implant neuroelectrodes J1 0061 64581 Implant neuroelectrodes J1 0061 0039 36870 Percut thrombect av fistula J1 0083 36870 Percut thrombect av fistula J1 0083 0229 92920 Prq cardiac angioplast 1 art J1 0083 92920 Prq cardiac angioplast 1 art J1 0083 0229 92920 Prq cardiac angioplast 1 art J1 0083 92921 Prq cardiac angio addl art N 0229 33207 Insert heart pm ventricular J1 0089 33225 L ventric pacing lead add-on N 0655 33208 Insrt heart pm atrial & vent J1 0089 33225 L ventric pacing lead add-on N 0655
Updates Affecting OPPS Payments Addendum J for CY2015 complexity adjustments of combinations of comprehensive HCPCS codes Secondary or Secondary Complexity Primary HCPCS Primary Primary APC Device Add-on Secondary APC Adjusted APC Code Primary Short Descriptor SI Assignment HCPCS Code Secondary Short Descriptor SI Assignment Assignment 33208 Insrt heart pm atrial & vent J1 0089 93650 Ablate heart dysrhythm focus J1 0085 0655 33224 Insert pacing lead & connect J1 0089 33216 Insert 1 electrode pm-defib J1 0090 0655 33228 Remv&replc pm gen dual lead J1 0089 33225 L ventric pacing lead add-on N 0655 33233 Removal of pm generator J1 0090 33225 L ventric pacing lead add-on N 0089 33282 Implant pat-active ht record J1 0090 93619 Electrophysiology evaluation J1 0085 0089 33282 Implant pat-active ht record J1 0090 93620 Electrophysiology evaluation J1 0085 0089 57260 Repair of vagina J1 0202 57288 Repair bladder defect J1 0202 0385 57265 Extensive repair of vagina J1 0202 57288 Repair bladder defect J1 0202 0385 57282 Colpopexy extraperitoneal J1 0202 57260 Repair of vagina J1 0202 0385 57282 Colpopexy extraperitoneal J1 0202 57265 Extensive repair of vagina J1 0202 0385 57282 Colpopexy extraperitoneal J1 0202 57285 Repair paravag defect vag J1 0202 0385 57282 Colpopexy extraperitoneal J1 0202 57288 Repair bladder defect J1 0202 0385 57282 Colpopexy extraperitoneal J1 0202 58262 Vag hyst including t/o J1 0202 0385 57283 Colpopexy intraperitoneal J1 0202 57285 Repair paravag defect vag J1 0202 0385 57283 Colpopexy intraperitoneal J1 0202 57288 Repair bladder defect J1 0202 0385 57285 Repair paravag defect vag J1 0202 57288 Repair bladder defect J1 0202 0385 57288 Repair bladder defect J1 0202 57250 Repair rectum & vagina J1 0202 0385 57288 Repair bladder defect J1 0202 58260 Vaginal hysterectomy J1 0202 0385 57288 Repair bladder defect J1 0202 58263 Vag hyst w/t/o & vag repair J1 0202 0385 57288 Repair bladder defect J1 0202 58270 Vag hyst w/enterocele repair J1 0202 0385
Updates Affecting OPPS Payments Addendum J for CY2015 complexity adjustments of combinations of comprehensive HCPCS codes Primary APC Secondary or Device Add- Secondary APC Complexity Adjusted Primary HCPCS Code Primary Short Descriptor Primary SI Assignment on HCPCS Code Secondary Short Descriptor Secondary SI Assignment APC Assignment 58262 Vag hyst including t/o J1 0202 57288 Repair bladder defect J1 0202 0385 37221 Iliac revasc w/stent J1 0229 37236 Open/perq place stent 1st J1 0229 0319 37225 Fem/popl revas w/ather J1 0229 37221 Iliac revasc w/stent J1 0229 0319 37225 Fem/popl revas w/ather J1 0229 37236 Open/perq place stent 1st J1 0229 0319 37226 Fem/popl revasc w/stent J1 0229 37221 Iliac revasc w/stent J1 0229 0319 37226 Fem/popl revasc w/stent J1 0229 37225 Fem/popl revas w/ather J1 0229 0319 37226 Fem/popl revasc w/stent J1 0229 37226 Fem/popl revasc w/stent J1 0229 0319 37226 Fem/popl revasc w/stent J1 0229 37236 Open/perq place stent 1st J1 0229 0319 37226 Fem/popl revasc w/stent J1 0229 C9600 Perc drug-el cor stent sing J1 0229 0319 37241 Vasc embolize/occlude venous J1 0229 37238 Open/perq place stent same J1 0229 0319 37242 Vasc embolize/occlude artery J1 0229 37221 Iliac revasc w/stent J1 0229 0319 37242 Vasc embolize/occlude artery J1 0229 37236 Open/perq place stent 1st J1 0229 0319 37243 Vasc embolize/occlude organ J1 0229 37221 Iliac revasc w/stent J1 0229 0319 37243 Vasc embolize/occlude organ J1 0229 37236 Open/perq place stent 1st J1 0229 0319 37244 Vasc embolize/occlude bleed J1 0229 37221 Iliac revasc w/stent J1 0229 0319 37244 Vasc embolize/occlude bleed J1 0229 37236 Open/perq place stent 1st J1 0229 0319 37244 Vasc embolize/occlude bleed J1 0229 37238 Open/perq place stent same J1 0229 0319 92928 Prq card stent w/angio 1 vsl J1 0229 C9601 Perc drug-el cor stent bran N 0319 C9600 Perc drug-el cor stent sing J1 0229 33208 Insrt heart pm atrial & vent J1 0089 0319 C9600 Perc drug-el cor stent sing J1 0229 33210 Insert electrd/pm cath sngl J1 0090 0319 C9600 Perc drug-el cor stent sing J1 0229 37221 Iliac revasc w/stent J1 0229 0319 C9600 Perc drug-el cor stent sing J1 0229 37236 Open/perq place stent 1st J1 0229 0319 C9600 Perc drug-el cor stent sing J1 0229 92924 Prq card angio/athrect 1 art J1 0229 0319 C9600 Perc drug-el cor stent sing J1 0229 C9600 Perc drug-el cor stent sing J1 0229 0319 C9600 Perc drug-el cor stent sing J1 0229 C9601 Perc drug-el cor stent bran N 0319 C9600 Perc drug-el cor stent sing J1 0229 C9605 Perc d-e cor revasc t cabg b N 0319 C9604 Perc d-e cor revasc t cabg s J1 0229 C9600 Perc drug-el cor stent sing J1 0229 0319 C9604 Perc d-e cor revasc t cabg s J1 0229 C9601 Perc drug-el cor stent bran N 0319 C9604 Perc d-e cor revasc t cabg s J1 0229 C9604 Perc d-e cor revasc t cabg s J1 0229 0319 C9604 Perc d-e cor revasc t cabg s J1 0229 C9605 Perc d-e cor revasc t cabg b N 0319
Updates Affecting OPPS Payments For the following Composite APCs (Status Indicator Q3), no changes in 2015 – Extended Assessment and Management (APC 8009) – LDR Prostate Brachytherapy (APC 8001) – Mental Health Services (APC 0034) – Multiple Imaging (APCs 8004, 8005, 8006, 8007 and 8008) Composite APCs for Cardiac Resynchronization Therapy (APC 0108) and EP Evaluation and Ablation (APC 8000) have been eliminated Both now paid as C-APCs
Packaging Policy Changes for 2015
Packaging Policy Changes for 2015 Ancillary services/procedures with a geometric mean cost of $100 or less will be conditionally packaged – Only paid if that is only service on claim – Excluded are preventive services that would be otherwise packaged
Packaging Policy Changes for 2015 Ancillary services/procedures with a geometric mean cost of $100 will be conditionally packaged – Also excluded are: • Certain psychiatric and counseling services that are considered by CMS to be visits and not ancillary such as psychotherapy, etc. • Drug administration and add-on drug administration CPT Codes – “We are examining various alternative payment policies for drug administration services…..” Status Indicator X (Ancillary Services) is being eliminated since most services are now conditionally packaged as Status Indicator Q1 (STV Packaged) – CPT Codes previously “X” and not “Q1” will be assigned as Status Indicator “S” (Significant Procedure Not Discounted)
Packaging Policy Changes for 2015 Ancillary services/procedures with a geometric mean cost of $100 will be conditionally packaged – Many, many procedures and tests are now packaged • Check that list of CPT Codes with Comment Indicator “CH” and Status Indicator “Q1” • Partial list is included on the next page – Includes many radiology exams, EKGs, laceration repairs, surgical pathology and cytology tests Prosthetic supplies that were paid separately in 2014 will now be packaged into the related surgical procedure – This includes not only the prosthetic supplies related to an implanted device but also the implanted device – Status Indicator changed from “A” to “N” for all DMEPOS prosthetic supplies
Packing Policy Changes for 2015 HCPCS Code Short Descriptor CI SI APC Payment Rate 12001 Rpr s/n/ax/gen/trnk 2.5cm/< CH Q1 0012 $98.46 70160 X-ray exam of nasal bones CH Q1 0260 $59.34 71021 Chest x-ray frnt lat lordotc CH Q1 0260 $59.34 71022 Chest x-ray frnt lat oblique CH Q1 0261 $94.98 71023 Chest x-ray and fluoroscopy CH Q1 0261 $94.98 71030 Chest x-ray 4/> views CH Q1 0261 $94.98 71035 Chest x-ray special views CH Q1 0260 $59.34 71100 X-ray exam ribs uni 2 views CH Q1 0260 $59.34 71101 X-ray exam unilat ribs/chest CH Q1 0261 $94.98 71110 X-ray exam ribs bil 3 views CH Q1 0261 $94.98 73020 X-ray exam of shoulder CH Q1 0260 $59.34 73500 X-ray exam of hip CH Q1 0260 $59.34 73560 X-ray exam of knee 1 or 2 CH Q1 0260 $59.34 73562 X-ray exam of knee 3 CH Q1 0261 $94.98 73564 X-ray exam knee 4 or more CH Q1 0261 $94.98 73565 X-ray exam of knees CH Q1 0260 $59.34 73600 X-ray exam of ankle CH Q1 0261 $94.98 73610 X-ray exam of ankle CH Q1 0261 $94.98 73620 X-ray exam of foot CH Q1 0260 $59.34 73630 X-ray exam of foot CH Q1 0260 $59.34 73650 X-ray exam of heel CH Q1 0260 $59.34 73660 X-ray exam of toe(s) CH Q1 0260 $59.34 74000 X-ray exam of abdomen CH Q1 0260 $59.34 74010 X-ray exam of abdomen CH Q1 0260 $59.34 74020 X-ray exam of abdomen CH Q1 0261 $94.98
Updates Affecting OPPS Payments-Other Issues • Calculation of the Adjusted Medicare Payment from the National Unadjusted Medicare Payment – Assuming the following: APC 0019=$380.32; Wage index for NY CBSA 35644= 1.3147 • Labor adjusted portion of full national adjusted payment= $300.00 (.60 * $380.32 * 1.3147) • The nonlabor-related portion of the full national unadjusted payment = $152.13 (.40 * $380.32) • Total Adjusted Medicare Payment= $452.13 ($300.00 + $152.13) • National beneficiary copayment cannot exceed 40% of the APC payment in 2015 and cannot be less than 20% of the OPD fee schedule amount – Beneficiary copayment collected is limited to the amount of the inpatient deductible.
OPPS APC Group Policies
OPPS APC Group Policies
OPPS APC Group Policies
OPPS APC Group Policies
OPPS APC Group Policies
OPPS APC Group Policies
OPPS APC Group Policies Process for new CPT Codes effective January 1, 2016 – Under the current process, CPT Codes effective January 1 are given interim Status Indicator and APC assignments until the following year’s OPPS Rule when Status Indicators and APCs are finalized for the previous year’s new CPT Codes – The following process will be implemented for January 1, 2016 • New and revised CPT Codes that are received too late for inclusion in the 2016 OPPS Proposed Rule would not be used by CMS until January 1, 2017 – HCPCS G-codes would be created by CMS to describe the predecessor CPT Codes for the new or revised CPT Codes that are part of the annual 2016 CPT Code update
OPPS APC Group Policies Process for new CPT Codes effective January 1, 2016 • For new CPT Codes that are released publicly by the AMA prior to the proposed 2016 rule, Status Indicators and APCs will be assigned for 2016 • CMS is hoping that AMA adjusts the timeline for the release of the new CPT Codes to allow the new, revised, and deleted CPT Codes to be included in the Proposed OPPS Rule each year. – AMA requested a delay until 2017 but CMS refused
2015 OPPS APC Specific Policies APCs are being restructured in 3 areas this year: – In ophthalmology, the number of APCs reduced from 24 levels in 2014 to 13 levels in 2015 – For female reproductive APCs, there is restructuring of the APCs resulting in 5 APC levels in 2015 versus 7 APC levels in 2014 – For cystourethroscopy and other genitourinary procedures, there is restructuring of the APCs resulting in 4 APC levels in 2015 versus 5 APC levels in 2014
2015 OPPS APC Specific Policies For image-guided breast biopsies, APC 037 is being deleted and all CPT Codes reassigned to APC 005 resulting in a $350 increase in payment
2015 OPPS APC Specific Policies For image-guided breast biopsies, APC 037 is being deleted and all CPT Codes reassigned to APC 005 resulting in a $350 increase in payment
2015 OPPS APC Specific Policies For image-guided breast biopsies, APC 037 is being deleted and all CPT Codes reassigned to APC 005 resulting in a $350 increase in payment
2015 Payment Changes for Devices Pass-through Devices – Devices with pass through status eligible for pass through payment for at least 2 years but not more than 3 years – Devices no longer eligible for pass through payment are packaged into the cost of the procedure – As of January 1, 2015, there is one device eligible for pass-through payment • C1841 Retinal prosthesis, includes all internal and external components – Pass-through status scheduled to expire as of January 1, 2016
2015 Payment Changes for Devices For replaced devices that there is at least 50% credit, current 2014 policy continues – Credit amount reported in the amount field for Value Code “FD” • Value Code FD=Credit received from manufacturer for replaced medical device
2015 Payment Changes for Drugs, Biologicals, and Radiopharmaceuticals For drugs and biologicals, pass-through payment is the amount by which the drug or biological exceeds the portion of the otherwise applicable Medicare OPD fee schedule that is associated with the drug or biological (SI=G) Due to the postponement of the Part B Drug Competitive Acquisition Program, CMS pays the rate paid in the physician's office setting for all drugs and biologicals with pass-through status – ASP + 6%
2015 Payment Changes for Drugs, Biologicals, and Radiopharmaceuticals 9 drugs with pass-through status ending December 31, 2014
2015 Payment Changes for Drugs, Biologicals, and Radiopharmaceuticals 22 drugs/biologicals have pass-through status (SI=G) in 2015
2015 Payment Changes for Drugs, Biologicals, and Radiopharmaceuticals 22 drugs/biologicals have pass-through status (SI=G) in 2015
2015 Payment Changes for Drugs, Biologicals, and Radiopharmaceuticals 22 drugs/biologicals have pass-through status (SI=G) in 2015
2015 Payment Changes for Drugs, Biologicals, and Radiopharmaceuticals $95 per day cost threshold for separate payment (SI=K) of non-pass through drugs with payment at ASP+6% ($90 in 2014) Packaging determinations will be made on a drug-specific basis rather than a HCPCS Code-specific basis for those HCPCS codes that describe the same drug or biological but different doses Non-pass-through therapeutic radiopharmaceuticals (per day cost of $95) payment is ASP + 6% Currently one diagnostic radiopharmaceutical with pass-through payment • A9520 (previously C1204) Technetium Tc 99m tilmanocept, diagnostic, up to 0.5 millicuries Pass-through status granted October 1, 2013 Blood clotting factors under OPPS to be paid at ASP+6%
2015 Payment Changes for Drugs, Biologicals, and Radiopharmaceuticals Methodology for calculating high cost versus low cost skin substitutes is changing for 2015 – In 2014, skin substitutes with a July 2013 ASP + 6% amount above $32 per square cm were classified as “high cost” – In 2015, skin substitutes with a weighted average mean unit cost (MUC) above $25 per square cm using 2013 claims data will be classified as “high cost”
2015 Payment Changes for Drugs, Biologicals, and Radiopharmaceuticals
2015 Payment Changes for Drugs, Biologicals, and Radiopharmaceuticals
Other 2015 OPPS Payment and Coding Changes Hospital coding and payment for visits – Current single HCPCS Code G0463 for clinic visits will continue to be used in 2015 – No changes to current ED level structure – For critical care CPT Code 99291, current policy continues in 2015 that conditionally packages ancillary services reported on same day as the critical care services
Other 2015 OPPS Payment and Coding Changes • Inpatient only list is detailed in Addendum E • One CPT Code added to the inpatient only list in 2015 – CPT 22222-Osteotomy of spine, including discectomy, anterior approach, single vertebral segment; thoracic • Two CPT Codes removed from the inpatient only list in 2015 – CPT 63043-Laminonotomy with decompression of nerve root, each additional cervical interspace – CPT 63044-Laminonotomy with decompression of nerve root, each additional lumbar interspace
2015 Nonrecurring Policy Changes • Collecting data on services furnished in off-campus provider-based departments – Increased trend toward hospitals acquisition of physician practices, integration of those practices as hospital departments, and resultant increase in physician services being provided in hospital setting • CMS interested in how this trend affects payment under MPFS and OPPS • Conditions required for a provider to treat off-campus facility as provider based are included under 42 CFR 413 .65 – Campus defined as physical area immediately adjacent to the providers main buildings, other areas and structures that are not strictly contiguous to the main buildings but are located within 250 yards of the main buildings, and other areas determined on an individual case basis, by the CMS regional office, to be part of the provider’s campus
2015 Nonrecurring Policy Changes • CMS to create a HCPCS modifier to be reported on the CMS-1450 for hospital outpatient services – Voluntary reporting of the modifier in 2015 and required in 2016 – HCPCS modifier “PO” - Services, procedures and/or surgeries furnished at off-campus provider based outpatient departments • CMS to create two new “Place of Service” (POS) Codes to be reported on the CMS-1500 for physician services – Voluntary reporting of the modifier in 2015 and required in 2016 – POS 22 to be deleted and replaced with 2 new POS codes
OPPS Payment Status and Comment Indicators • Addendum B of the Federal Register is your "guide" – Pay attention to items with the following status indicators changes: • “X"-This status indicator will be deleted and replaced with either “Q1” or “S” • Complete list of 2015 status indicators are listed in Addendum D1
OPPS Payment Status and Comment Indicators • Addendum B of the Federal Register is your "guide" – Pay attention to items with the following comment indicators: • "CH"-Active HCPCS code with change in status indicator or APC assignment or active HCPCS code that is being discontinued. • "NI"-New code for 2015 or existing code with substantial change in 2015 with code descriptor or APC assignment
CPT Code Revisions Determine what the CPT Code revision impacts Revise charge master and related subsystems Provide education to clinical department Verify the CPT codes are revised accurately Determine if pricing change is required Monitor and test CPT Codes 66
CPT Code Additions Determine if new CPT Code is new service or replaces a deleted CPT Code Determine if new CPT Code is reimburseable – Category 3 CPT Codes implemented by CMS in July Determine if new CPT Code requires a pricing revision Revise charge master and related subsystems Provide education to clinical department Verify the CPT codes are added correctly Monitor and test CPT Codes 67
CPT Code Deletions Determine if there is a replacement for CPT Code deletion – Determine replacement CPT Code Revise charge master and related subsystems Provide education to clinical department Verify the CPT codes are deleted Monitor and test replacement CPT Codes 68
Laboratory Major changes to the Drug Assay Section (Note that CMS is not implementing these changes in 2015-all are Status Indicator B)) – Drug Assay section divided into two major categories: • Presumptive Drug Class procedures – Identifies possible use or non-use of a drug or a drug class – Includes immunoassays (EIA, ELISA, etc.), enzymatic methods, and chromatographic methods without mass spectrometry • Definitive Drug Class procedures – Qualitative or quantitative tests to identify possible use or non-use of a drug – Includes gas chromatography with mass spectrometry and liquid chromatography mas spectrometry but excludes immunoassays and enzymatic methods 69
Laboratory Presumptive Drug Class Screening • Divided into Drug Class List A or Drug Class List B • Drug Class List A typically consists of method in which results are capable of being read by: direct optical observation; or – – by instrumented test systems such as discrete multichannel chemistry analyzers using immunoassay or enzyme assay • Drug Class List B typically consists of methods that require more resources than a List A” drug test – Manual process such as ELISA 70
Laboratory Presumptive Drug Class Screening • CPT Code structure is based on type of method and whether Drug Class A or B – Separate CPT Codes for Thin Layer Chromatography (TLC) and separate CPT Codes for non-TLC methods: – For Class A Drugs, use 80300 for any number of drug classes with non-TLC method per date of service – For Class A Drugs, use 80303 for any number of drug classes using TLC per date of service – For Class A Drugs, use 80301 for single drug class method, non- TLC per date of service – For Class B Drugs, use 80302 for any number of drug classes with non-TLC method each procedure – For Class B Drugs, use 80303 for any number of drug classes using TLC per date of service – For either Drug Class A or B, not otherwise specified method such as DART, DESI, each procedure 71
Laboratory Definitive Drug Testing • Definitive drug testing methods include: – Gas chromatography with spectrometry – Liquid chromatography mass spectrometry – Excludes immunoassays and enzymatic assays • Definitive drug classes listing provides: – Drug classes and associated CPT Codes – Listing of drugs included in the drug class – Metabolites not listed may be reported using parent drug code – Drug classes may contain one or more CPT Codes based on the number of analytes – Includes CPT Codes 80320 through 80377 72
Laboratory Several changes to the Molecular Pathology Section – Several CPT Codes added to the Tier 1 molecular pathology procedures – For CPT Codes 81400-81408, numerous revisions to genes tested – New section created for Genomic Sequencing procedures and Molecular Multianalyte Assays • CPT Codes 81410 through 81471 73
Laboratory In Surgical Pathology, there were a number of changes to “correct” problems – In 2014, CPT Codes were added/revised related to immunohistochemistry antibody slides: • 88342 revised to “Immunohistochemistry, each separately identifiable antibody per block , first separately identifiable antibody per slide” • 88343 was added- “Immunohistochemistry, each separately identifiable antibody per block , each additional separately identifiable antibody per slide” – In 2015, CPT Codes were again added/revised related to immunohistochemistry antibody slides: • 88342 revised to “Immunohistochemistry, per specimen , initial single antibody stain procedure” • 88343 was deleted • 88341 was added- “Immunohistochemistry, per specimen , each additional single antibody stain procedure” • 88344 was added- “Immunohistochemistry , per specimen, each multiplex antibody stain procedure” (replaces G0461 and G0462) • More than one unit of 88341, 88342 or 88344 cannot be reported for same antibody 74
Laboratory CPT Additions For Presumptive Drug Class Screening, the following CPT Codes were added: 2015 CPT Code Description Department 80300 DRUG SCREEN LIST A ANY NMBR NON TLC DEVICES Laboratory 80301 DRUG SCREEN LIST A SINGLE DRUG CLASS METHOD Laboratory 80302 DRUG SCREEN PRESUMPTIVE 1 CLASS METHOD LIST B Laboratory 80303 DRUG SCREEN PRSMPTV 1/MULT CLASS METHOD TLC Laboratory 80304 DRUG SCREEN PRSMPTV 1/MULT CLASS METHOD Laboratory 75
Laboratory CPT Additions For Definitive Drug Class Screening, the following CPT Codes were added: 2015 CPT Code Description Department 80163 DRUG SCREEN QUANTITATIVE DIGOXIN FREE Laboratory 80165 DRUG SCREEN QUANT DIPROPYLACETIC ACID FREE Laboratory 80320 DRUG SCREEN QUANTITATIVE ALCOHOLS Laboratory 80321 DRUG SCREEN QUANT ALCOHOLS BIOMARKERS 1 OR 2 Laboratory 80322 DRUG SCREEN QUANT ALCOHOLS BIOMARKERS 3 OR MORE Laboratory 80323 ALKALOIDS NOT OTHERWISE SPECIFIED Laboratory 80324 DRUG SCREEN QUANT AMPHETAMINES 1 OR 2 Laboratory 80325 DRUG SCREEN QUANT AMPHETAMINES 3 OR 4 Laboratory 80326 DRUG SCREEN QUANT AMPHETAMINES 5 OR MORE Laboratory 80327 DRUG SCREEN QUANT ANABOLIC STEROID 1 OR 2 Laboratory 80328 DRUG SCREEN QUANT ANABOLIC STEROID 3 OR MORE Laboratory 80329 DRUG SCREEN ANALGESICS NON ‐ OPIOID 1 OR 2 Laboratory 80330 DRUG SCREEN ANALGESICS NON ‐ OPIOID 3 ‐ 5 Laboratory 80331 DRUG SCREEN ANALGESICS NON ‐ OPIOID 6 OR MORE Laboratory 80332 ANTIDEPRESSANTS SEROTONERGIC CLASS 1 OR 2 Laboratory 80333 ANTIDEPRESSANTS SEROTONERGIC CLASS 3 ‐ 5 Laboratory 80334 ANTIDEPRESSANTS SEROTONERGIC CLASS 6 OR MORE Laboratory 80335 ANTIDEPRESSANTS TRICYCLIC OTHER CYCLICALS 1 OR 2 Laboratory 76
Laboratory CPT Additions For Definitive Drug Class Screening, the following CPT Codes were added: 2015 CPT Code Description Department 80336 ANTIDEPRESSANTS TRICYCLIC OTHER CYCLICALS 3 ‐ 5 Laboratory 80337 ANTIDEPRESSANTS TRICYCLIC OTHER CYCLICALS 6/MORE Laboratory 80338 ANTIDEPRESSANTS NOT OTHERWISE SPECIFIED Laboratory 80339 ANTIEPILEPTICS NOT OTHERWISE SPECIFIED 1 ‐ 3 Laboratory 80340 ANTIEPILEPTICS NOT OTHERWISE SPECIFIED 4 ‐ 6 Laboratory 80341 ANTIEPILEPTICS NOT OTHERWISE SPECIFIED 7/MORE Laboratory 80342 ANTIPSYCHOTICS NOT OTHERWISE SPECIFIED 1 ‐ 3 Laboratory 80343 ANTIPSYCHOTICS NOT OTHERWISE SPECIFIED 4 ‐ 6 Laboratory 80344 ANTIPSYCHOTICS NOT OTHERWISE SPECIFIED 7/MORE Laboratory 80345 DRUG SCREENING BARBITURATES Laboratory 80346 DRUG SCREENING BENZODIAZEPINES 1 ‐ 12 Laboratory 80347 DRUG SCREENING BENZODIAZEPINES 13 OR MORE Laboratory 80348 DRUG SCREENING BUPRENORPHINE Laboratory 80349 DRUG SCREENING CANNABINOIDS NATURAL Laboratory 80350 DRUG SCREENING CANNABINOIDS SYNTHETIC 1 ‐ 3 Laboratory 80351 DRUG SCREENING CANNABINOIDS SYNTHETIC 4 ‐ 6 Laboratory 80352 DRUG SCREENING CANNABINOIDS SYNTHETIC 7/MORE Laboratory 80353 DRUG SCREENING COCAINE Laboratory 80354 DRUG SCREENING FENTANYL Laboratory 80355 DRUG SCREENING GABAPENTIN NON ‐ BLOOD Laboratory 77
Laboratory CPT Additions For Definitive Drug Class Screening, the following CPT Codes were added: 2015 CPT Code Description Department 80356 DRUG SCREENING HEROIN METABOLITE Laboratory 80357 DRUG SCREENING KETAMINE AND NORKETAMINE Laboratory 80358 DRUG SCREENING METHADONE Laboratory 80359 DRUG SCREENING METHYLENEDIOXYAMPHETAMINES Laboratory 80360 DRUG SCREENING METHYLPHENIDATE Laboratory 80361 DRUG SCREENING OPIATES 1 OR MORE Laboratory 80362 DRUG SCREENING OPIOIDS AND OPIATE ANALOGS 1 OR 2 Laboratory 80363 DRUG SCREENING OPIOIDS AND OPIATE ANALOGS 3 OR 4 Laboratory 80364 DRUG SCREENING OPIOIDS & OPIATE ANALOGS 5/MORE Laboratory 80365 DRUG SCREENING OXYCODONE Laboratory 80366 DRUG SCREENING PREGABALIN Laboratory 80367 DRUG SCREENING PROPOXYPHENE Laboratory 80368 DRUG SCREENING SEDATIVE HYPNOTICS Laboratory 80369 DRUG SCREENING SKELETAL MUSCLE RELAXANTS 1 OR 2 Laboratory 80370 DRUG SCREENING SKEL MUSCLE RELAXANTS 3 OR MORE Laboratory 80371 DRUG SCREENING STIMULANTS SYNTHETIC Laboratory 80372 DRUG SCREENING TAPENTADOL Laboratory 80373 DRUG SCREENING TRAMADOL Laboratory 80374 DRUG SCREEN STEREOISOMER ANALYSIS 1 DRUG CLASS Laboratory 80375 DRUG/SUBSTANCE DEFINITIVE QUAL/QUANT NOS 1 ‐ 3 Laboratory 80376 DRUG/SUBSTANCE DEFINITIVE QUAL/QUANT NOS 4 ‐ 6 Laboratory 80377 DRUG/SUBSTANCE DEFINITIVE QUAL/QUANT NOS 7/MORE Laboratory 78
Laboratory CPT Additions For Tier 1 Molecular Pathology Procedures, there were several additions: 2015 CPT Code Description Department 81246 FLT3 GENE ANLYS TYROSINE KINASE DOMAIN VARIANTS Moleculary Pathology 81288 MLH1 GENE ANALYSIS PROMOTER METHYLATION ANALYSIS Moleculary Pathology 81313 PCA3/KLK3 PROSTATE SPECIFIC ANTIGEN RATIO Moleculary Pathology 79
Laboratory CPT Additions For Genomic Sequencing Procedures, the following CPT Codes were added: 2015 CPT Code Description Department 81410 AORTIC DYSFUNCTION/DILATION GENOMIC SEQ ANALYSIS Moleculary Pathology 81411 AORTIC DYSFUNCTION/DILATION DUP/DEL ANALYSIS Moleculary Pathology 81415 EXOME SEQUENCE ANALYSIS Moleculary Pathology 81416 EXOME SEQUENCE ANALYSIS EACH COMPARATOR EXOME Moleculary Pathology 81417 EXOME RE ‐ EVAL OF PREVIOUSLY OBTAINED EXOME SEQ Moleculary Pathology 81420 FETAL CHROMOSOMAL ANEUPLOIDY GENOMIC SEQ ANALYS Moleculary Pathology 81425 GENOME SEQUENCE ANALYSIS Moleculary Pathology 81426 GENOME SEQUENCE ANALYSIS EACH COMPARATOR GENOME Moleculary Pathology 81427 GENOME RE ‐ EVALUATION OF PREC OBTAINED GENOME SEQ Moleculary Pathology 81430 HEARING LOSS GENOMIC SEQUENCE ANALYSIS 60 GENES Moleculary Pathology 81431 HEARING LOSS DUP/DEL ANALYSIS Moleculary Pathology 81435 HEREDITARY COLON CA GENOMIC SEQ ANALYS 7 GENES Moleculary Pathology 81436 HEREDITARY COLON CA SYND DUP/DEL ANALYS 8 GENES Moleculary Pathology 81440 NUCLEAR MITOCHONDRIAL 100 GENE GENOMIC SEQ Moleculary Pathology 81445 TARGETED GENOMIC SEQ ANALYS DNA ANALYS 5 ‐ 50 GENE Moleculary Pathology 81450 GENOMIC SEQ ANALYS DNA&RNA ANALYS 5 ‐ 50 GENE Moleculary Pathology 81455 GENOMIC SEQ ANALYS DNA&RNA ANALYS 51/MORE GENES Moleculary Pathology 81460 WHOLE MITOCHONDRIAL GENOME Moleculary Pathology 81465 WHOLE MITOCHONDRIAL GENOME ANALYSIS PANEL Moleculary Pathology 81470 X ‐ LINKED INTELLECTUAL DBLT GENOMIC SEQ ANALYS Moleculary Pathology 81471 X ‐ LINKED INTELLECTUAL DBLT DUP/DEL GENE ANALYS Moleculary Pathology 81519 ONCOLOGY BREAST MRNA GENE EXPRESSION 21 GENES Moleculary Pathology 80
Laboratory CPT Additions Other additions include: 2015 CPT Code Description Department 83006 GROWTH STIMULATION EXPRESSED GENE 2 Laboratory 87505 NFCT AGENT DNA/RNA GASTROINTESTINAL PATHOGEN Laboratory 87506 IADNA ‐ DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 6 ‐ 11 Laboratory 87507 IADNA ‐ DNA/RNA GI PTHGN MULTIPLEX PROBE TQ 12 ‐ 25 Laboratory 87623 IADNA HUMAN PAPILLOMAVIRUS LOW ‐ RISK TYPES Laboratory 87624 IADNA HUMAN PAPILLOMAVIRUS HIGH ‐ RISK TYPES Laboratory 87625 IADNA HUMAN PAPILLOMAVIRUS TYPES 16 & 18 ONLY Laboratory 87806 IAADIADOO HIV1 ANTIGEN W/HIV1 & HIV2 ANTIBODIES Laboratory 81
Laboratory CPT Additions Other additions in Pathology include: 2015 CPT Code Description Department 88341 IMHISTOCHEM/CYTCHM EA ADDL ANTIBODY SLIDE Pathology 88344 IMHISTOCHEM/CYTCHM EA MULTIPLEX ANTIBODY SLIDE Pathology 88364 IN SITU HYBRIDIZATION EA ADDL PROBE STAIN Pathology 88366 IN SITU HYBRIDIZATION EA MULTIPLEX PROBE STAIN Pathology 88369 M/PHMTRC ALYS ISH QUANT/SEMIQ MNL PER SPEC EACH Pathology 88373 M/PHMTRC ALYS ISH QUANT/SEMIQ CPTR PER SPEC EACH Pathology 88374 M/PHMTRC ALYS ISH QUANT/SEMIQ CPTR EACH MULTIPRB Pathology 88377 M/PHMTRC ALYS ISH QUANT/SEMIQ MNL EACH MULTIPRB Pathology 89337 CRYOPRESERVATION MATURE OOCYTE(S) Pathology 0357T CRYOPRESERVATION IMMATURE OOCYTE(S) Pathology 82
Laboratory CPT Deletions 2014 Replacement CPT 2015 CPT Code Description Department Code 80100 DRUG SCR QUAL MLT DRUG CLASSES CHROM EA PX Laboratory 80300 ‐ 80304 80101 DRUG SCR QUAL 1 DRUG CLASS METH EA DRUG CLASS Laboratory 80300 ‐ 80304 80102 DRUG CONFIRMATION EACH PROCEDURE Laboratory 80300 ‐ 80304 80103 TISSUE PREPARATION DRUG ANALYSIS Laboratory 80300 ‐ 80304 80104 DRUG SCRN QUAL MLT CLASS NONCHROMOTOGRAPHIC EACH Laboratory 80300 ‐ 80304 80152 DRUG SCREEN QUANTITATIVE AMITRIPTYLINE Laboratory 80335 ‐ 80337 80154 DRUG SCREEN QUANTITATIVE BENZODIAZEPINES Laboratory 80346, 80347 80160 DRUG SCREEN QUANTITATIVE DESIPRAMINE Laboratory 80335 ‐ 80337 80166 DRUG SCREEN QUANTITATIVE DOXEPIN Laboratory 80335 ‐ 80337 80172 DRUG SCREEN QUANTITATIVE GOLD Laboratory 80375 80174 DRUG SCREEN QUANTITATIVE IMIPRAMINE Laboratory 80335 ‐ 80337 80182 DRUG SCREEN QUANTITATIVE NORTRIPTYLINE Laboratory 80335 ‐ 80337 80196 DRUG SCREEN QUANTITATIVE SALICYLATE Laboratory 80329 ‐ 80331 80440 THYROTROPIN RELEAS HORMONE HYPRPROLACTINEMIA Laboratory 84146 83
Laboratory CPT Deletions 2014 Replacement CPT 2015 CPT Code Description Department Code 82000 ASSAY ACETALDEHYDE BLOOD Laboratory None 82003 ASSAY OF ACETAMINOPHEN Laboratory 80329 ‐ 80331 82055 ALCOHOL ANY SPECIMEN EXCEPT BREATH Laboratory 80320 ‐ 80322 82101 ALKALOIDS URINE QUANTITATIVE Laboratory 80323 82145 AMPHETAMINE/METHAMPHETAMINE Laboratory 80324 ‐ 80326 82205 BARBITURATES NOT ELSEWHERE SPECIFIED Laboratory 80345 82520 COCAINE/METABOLITE Laboratory 80353 82646 ASSAY OF DIHYDROCODEINONE Laboratory 80361 82649 ASSAY OF DIHYDROMORPHINONE Laboratory 80361 82651 ASSAY OF DIHYDROTSTOSTERONE Laboratory 80327, 80328 82654 ASSAY OF DIMETHADIONE Laboratory 80339 ‐ 80341 82666 ASSAY OF EPIANDROSTERONE Laboratory 80327, 80328 82690 ASSAY OF ETHCHLORVYNOL Laboratory 80320 82742 ASSAY OF FLURAZEPAM Laboratory 80346, 80347 82953 GLUC TOLBUTAMIDE TOLERANCE TST Laboratory None 82975 ASSAY OF GLUTAMINE Laboratory 8217, 82128, 82 82980 ASSAY OF GLUTETHIMIDE Laboratory None 83008 ASSAY OF GUANOSINE MONOPHOSPHATE CYCLIC Laboratory None 83055 HEMOGLOBIN SULFHEMOGLOBIN QUALITATIVE Laboratory None 83071 ASSAY OF HEMOSIDERIN QUANTITATIVE Laboratory None 83634 LACTOSE URINE QUANTITATIVE Laboratory None 83805 ASSAY OF MEPROBAMATE Laboratory 80369, 80370 83840 METHADONE Laboratory 80358 84
Laboratory CPT Deletions 2014 Replacement CPT 2015 CPT Code Description Department Code 83858 METHSUXIMIDE Laboratory 80339 ‐ 80341 83866 MUCOPOLYSACCHARIDES ACID SCREEN Laboratory None 83887 ASSAY OF NICOTINE Laboratory 80323 83925 OPIATE(S) DRUG AND METABOLITES EACH PROCEDURE Laboratory 80361 ‐ 80364 84022 ASSAY OF PHENOTHIAZINE Laboratory 80342 ‐ 80344 84127 PORPHYRINS FECES QUALITATIVE Laboratory None 87001 ANIMAL INOCULATION SMALL ANIMAL W/OBSERVATION Laboratory None 87620 IADNA PAPILLOMAVIRUS HUMAN DIRECT PROBE TQ Laboratory 87623 ‐ 87625 87621 IADNA PAPILLOMAVIRUS HUMAN AMPLIFIED PROBE TQ Laboratory 87623 ‐ 87625 87622 IADNA PAPILLOMAVIRUS HUMAN QUANTIFICATION Laboratory 87623 ‐ 87625 88343 IMHISTOCHEM/CYTCHM EA ADDL ANTIBODY SLIDE Pathology 88344 0059T CRYOPRESERVATION OOCYTES Pathology 89337 85
Laboratory Drug Testing CMS Exceptions For drug screening of drug classes, the new CPT Codes-80300 through 80304 are Status Indicator B – The HCPCS Codes used by CMS were changed in 2015 to Status Indicator N • G0431 Drug screen, qualitative; multiple drug classes by highly complex method per patient encounter – Used for instrument driven testing and chromatographic methods – 80301, 80302, 80303 and 80304 are probably the comparable 2015 CPT Codes • G0434 Drug screen, other than chromatographic; any number of drug classes, by CLIA waived test or moderate complexity test, per patient encounter – Used for CLIA waived tests and dipsticks, cups, cassettes – 80300 is probably the comparable 2015 CPT Code 86
Laboratory Drug Testing CMS Exceptions CMS is not accepting the new drug codes created by the AMA and has developed alternative HCPCS Codes 2015 CMS HCPCS Description Deleted 2014 CPT Code 2015 CPT Code G6030 Assay of amitriptyline 80152 80335,80336, or 80337 G6031 Assay of benzodiazepines 80154 80346, 80347 G6032 Assay of desipramine 80160 80335,80336, or 80337 G6034 Assay of doxepin 80166 80335,80336, or 80337 G6035 Assay of gold 80172 80375 G6036 Assay of Imipramine 80174 80335,80336, or 80337 G6037 Assay of nortiptyline 80182 80335,80336, or 80337 G6038 Assay of salicylate 80196 80329,80330 or 80331 G6039 Assay of acetaminophen 82003 80329,80330 or 80331 G6040 Assay of ethanol 82055 80320, 80321, or 80322 G6041 Assay of urine alkaloids 82101 80323 87
Laboratory Drug Testing CMS Exceptions CMS is not accepting the new drug codes created by the AMA and has developed alternative HCPCS Codes 2015 CMS HCPCS Description Deleted 2014 CPT Code 2015 CPT Code G6042 Assay of amphetamines 82145 80324,80325, or 80326 G6043 Assay of barbiturates 82205 80345 G6044 Assay of cocaine 82520 80353 G6045 Assay of dihydrocodeinone 82646 80361 G6046 Assay of dihydromorphinone 82649 80361 G6047 Assay of dihydrotestosterone 82651 80327, 80328 G6048 Assay of dimethadione 82654 80339, 80340, or 80341 G6049 Assay of Epiandrosterone 82666 80327, 80328 G6050 Assay of Ethchlorvynol 82690 80320 G6051 Assay of flurazepam 82742 80346, 80347 G6052 Assay of meprobamate 83805 80369, 80370 G6053 Assay of methadone 83840 80358 G6054 Assay of methsuximide 83858 80339, 80340, or 80341 88
Laboratory Drug Testing CMS Exceptions CMS is not accepting the new drug codes created by the AMA and has developed alternative HCPCS Codes 2015 CMS Deleted 2014 CPT HCPCS Description Code 2015 CPT Code G6055 Assay of nicotine 83887 80323 80361, 80362, Opiate(s),drug and metabolites, each 80363, or G6056 procedure 83925 80364 G6057 Assay of phenothiazine 84022 80342, G6058 drug confirmation 80102 Many 89
Laboratory CPT Revisions 2015 CPT Code Description Department 80162 DRUG SCREEN QUANTITATIVE DIGOXIN TOTAL Laboratory 80164 DRUG SCREEN QUANT DIPROPYLACETIC ACID TOTAL Laboratory 80171 DRUG SCREEN QUANTITATIVE GABAPENTIN Laboratory 80299 QUANTITATION DRUG NOT ELSEWHERE SPECIFIED Laboratory 84600 ASSAY OF VOLATILES Laboratory 86900 BLOOD TYPING SEROLOGIC ABO Laboratory 86901 BLOOD TYPING SEROLOGIC RH (D) Laboratory 86902 BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EACH Laboratory 86904 BLOOD TYPING ANTIGEN SCREEN PATIENT SERUM/UNIT Laboratory 86905 BLOOD TYPING RBC ANTIGENS OTH/THN ABO/RH D EACH Laboratory 86906 BLOOD TYPING SEROLOGIC RH PHENOTYPING COMPLETE Laboratory 87501 INFECTIOUS AGENT DNA/RNA INFLUENZA EA TYPE Laboratory 87502 INFECTIOUS AGENT DNA/RNA INFLUENZA 1ST 2 TYPES Laboratory 87503 NFCT AGENT DNA/RNA INFLUENZA 1/> TYPES EA ADDL Laboratory 87631 IADNA RESPIRATRY PROBE & REV TRNSCR 3 ‐ 5 TARGETS Laboratory 87632 IADNA RESPIRATRY PROBE & REV TRNSCR 6 ‐ 11 TARGETS Laboratory 87633 IADNA RESPIRATRY PROBE & REV TRNSCR 12 ‐ 25 TARGET Laboratory 88342 IMHISTOCHEM/CYTCHM INIT ANTIBODY STAIN PROCEDURE Pathology 88360 M/PHMTRC ALYS TUMOR IMHCHEM EA ANTIBODY MANUAL Pathology 88361 M/PHMTRC ALYS TUMOR IMHCHEM EA ANTBDY CMPTR ASST Pathology 88365 IN SITU HYBRIDIZATION 1ST PROBE STAIN Pathology 88367 M/PHMTRC ALYS ISH CPTR ‐ ASST TECH 1ST PROBE STAIN Pathology 88368 M/PHMTRC ALYS IN SITU HYBRIDIZATION EA PROBE MNL Pathology 90
Radiology For myelograms, the imaging and lumbar injection procedures are compressed into a single CPT Code for 2015: 62302-cervical 62303-thoracic 62304-lumbosacral 62305-2 or more regions Arthrocentesis is now frequently done under ultrasound guidance. New 2015 CPT Codes created that compress the arthrocentesis and ultrasound guidance into a single CPT Code; 20604 small joint 20606 intermediate joint 20611 large joint If arthrocentesis done under fluoroscopic, CT or MRI guidance , report surgical and imaging components separately 20600, 20605 or 20610 plus 77002, 77012, or 77021 91
Radiology For vertebroplasties and kyphoplasties, CPT Codes for the procedures were deleted: 22520 through 22525 along with the related imaging components: 72291 and 72292. Combined surgical/imaging CPT Codes were created: 22510-22512 for vertebroplasties 22513-22515 for kyphoplasties In Ultrasound, CPT 76645- “Ultrasound, breast, unilateral or bilateral” was deleted and replaced: 76641-Breast unilateral 76642-Breast bilateral In Mammography, CPT Codes were added for digital breast tomosynthesis 77061-Digital breast tomosynthesis, unilateral (Not paid by Medicare SI=E) 77062-Digital breast tomosynthesis, bilateral (Not paid by Medicare SI=E) G0279-Add on code for Digital breast tomosynthesis(SI=A $57) ? 77063 Screening digital breast tomosynthesis, bilateral(SI=A $57) This is an add-on Code to 77057 Screening Mammography 92
Radiology CPT Additions The following CPT Codes were added in Diagnostic Radiology and DEXA 2015 CPT Code Description Department 62302 MYELOGRAPHY VIA LUMBAR INJECTION RS&I CERVICAL Diagnostic Radiology 62303 MYELOGRAPHY VIA LUMBAR INJECTION RS&I THORACIC Diagnostic Radiology 62304 MYELOGRAPHY VIA LUMBAR INJECT RS&I LUMBOSACRAL Diagnostic Radiology 62305 MYELOGRAPHY VIA LUMBAR INJECTION RS&I 2+ REGIONS Diagnostic Radiology 77085 DXA BONE DENSITY STUDY AXIAL SKELETON DEXA Radiology 77086 VERTEBRAL FRACTURE ASSESSMENT VIA DXA DEXA Radiology 93
Radiology CPT Additions The following CPT Codes were added in Interventional Radiology 2015 CPT Code Description Department 20604 ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT Interventional Radiology 20606 ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/US Interventional Radiology 20611 ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US Interventional Radiology 20983 ABLATJ BONE TUMOR CRYO PERQ W/IMG GDN WHEN PRFMD Interventional Radiology, CT, MRI 22510 PERQ VERTEBROPLASTY UNI/BI INJX CERVICOTHORACIC Interventional Radiology 22511 PERQ VERTEBROPLASTY UNI/BI INJECTION LUMBOSACRAL Interventional Radiology 22512 VERTEBROPLASTY EACH ADDL CERVICOTHOR/LUMBOSACRAL Interventional Radiology 22513 PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULATION Interventional Radiology 22514 PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ LMBR Interventional Radiology 22515 PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ EACH Interventional Radiology 27279 ARTHRODESIS SACROILIAC JOINT PERCUTANEOUS Interventional Radiology 37218 TCATH STENT PLACEMT ANTEGRADE CAROTID/INNOMINATE Interventional Radiology 47383 ABLATION 1/> LIVER TUMOR PERQ CRYOABLATION Interventional Radiology, CT, MRI 0340T ABLATE PULM TUMORS W/PLEURA/CHEST WALL EXTSN Interventional Radiology 0347T PLACE INTERSTITIAL DEVICE(S) IN BONE FOR RSA Interventional Radiology 0348T RADIOSTEREOMETRIC ANALYSIS SPINE EXAM Interventional Radiology 0349T RADIOSTEREOMETRIC ANALYSIS UPPER EXTREMITY EXAM Interventional Radiology 0350T RADIOSTEREOMETRIC ANALYSIS LOWER EXTREMITY EXAM Interventional Radiology 0351T INTRAOP OCT BREAST OR AXILL NODE EACH SPECIMEN Interventional Radiology 0352T OCT BREAST OR AXILL NODE SPECIMEN I&R Interventional Radiology 0353T OCT OF BREAST SURG CAVITY REAL TIME INTRAOP Interventional Radiology 0354T OCT BREAST SURG CAVITY REAL TIME/REFERRED I&R Interventional Radiology 94
Radiology CPT Additions The following CPT Codes were added in Ultrasound/Mammography 2015 CPT Code Description Department 76641 US BREAST UNI REAL TIME WITH IMAGE COMPLETE Ultrasound/Mammography 76642 US BREAST UNI REAL TIME WITH IMAGE LIMITED Ultrasound/Mammography 77061 DIGITAL BREAST TOMOSYNTHESIS UNILATERAL Mammography 77062 DIGITAL BREAST TOMOSYNTHESIS BILATERAL Mammography 77063 SCREENING DIGITAL BREAST TOMOSYNTHESIS BI Mammography 95
Radiology CPT Deletions The following CPT Codes were deleted in Diagnostic Radiology and DEXA 2014 Replacement CPT 2015 CPT Code Description Department Code 74291 CHOLECYST ORAL CNTRST ADDL/REPEAT XM/MULT DAY XM Diagnostic Radiology None 77082 DXA BONE DENSITY STUDY VERTEBRAL FRACTURE Radiology DEXA 77086 96
Radiology CPT Deletions The following CPT Codes were deleted in Interventional Radiology 2014 Replacement CPT 2015 CPT Code Description Department Code 22520 PERCUTANEOUS VERTEBROPLSTY THORACIC W/WO BONE BX Interventional Radiology 22510 22521 PERCUTANEOUS VERTEBROPLASTY LUMBAR W/WO BNE BX Interventional Radiology 22511 22522 PERCUTANEOUS VERTEBROPLASTY EA ADDL THRC/LMBR Interventional Radiology 22512 22523 PERCUTANEOUS VERTEBRAL AUGMENTATION THORACIC Interventional Radiology 22513 22524 PERCUTANEOUS VERTEBRAL AUGMENTATION LUMBAR Interventional Radiology 22514 22525 PERQ VERTEBRAL AUGMENTATION EA ADDL THRC/LMBR Interventional Radiology 22515 72291 RAD S&I PERQ VRTPLS/SACRPLSTY PR VRT BODY FLUO Interventional Radiology 22510 ‐ 22515 72292 RAD S&I PERQ VRTPLS/SACRPLSTY PER VRT BODY CT Interventional Radiology 22510 ‐ 22515 97
Radiology CPT Deletions The following CPT Codes were deleted in Ultrasound: 2014 CPT Replacement 2015 CPT Code Description Department Code 76645 US BREAST REAL TIME W/IMAGE DOCUMENTATION Ultrasound Mammography 76641, 76642 98
Radiology CPT Revisions The following CPT Codes were revised in Diagnostic Radiology 2015 CPT Code Description Department 27370 INJECTION KNEE ARTHROGRAPHY Diagnostic Radiology 62284 INJECTION PROCEDURE MYELOGRAPHY/CT LUMBAR Diagnostic Radiology 99
Radiology CPT Revisions The following CPT Codes were revised in Interventional Radiology 2015 CPT Code Description Department 20600 ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US Interventional Radiology 20605 ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US Interventional Radiology 20610 ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US Interventional Radiology 20982 ABLATION BONE TUMOR RF PERQ W/IMG GDN WHEN DONE Interventional Radiology, CT, MRI 27280 ARTHRODESIS SACROILIAC JOINT W/OBTAINING GRAFT Interventional Radiology 37215 TCAT IV STENT CRV CRTD ART EMBOLIC PROTECJ Interventional Radiology 37216 TCAT IV STENT CRV CRTD ART W/O EMBOLIC PROTECJ Interventional Radiology 37217 TCATH STENT PLACEMT RETROGRAD CAROTID/INNOMINATE Interventional Radiology 37236 OPEN/PERQ PLACEMENT INTRAVASCULAR STENT INITIAL Interventional Radiology 37237 OPEN/PERQ PLACEMENT INTRAVASCULAR STENT EA ADDL Interventional Radiology 61055 CISTERNAL/LATERAL C1 ‐ C2 PUNCTURE W/INJECTION Interventional Radiology 0075T TCAT PLMT XTRC VRT CRTD STENT RS&I PRQ 1ST VSL Interventional Radiology 0076T TCAT PLMT XTRC VRT CRTD STENT RS&IPRQ EA VSL Interventional Radiology 0200T PERQ SAC AGMNTJ UNI W/WO BALO/MCHNL DEV 1/> NDL Interventional Radiology 0201T PERQ SAC AGMNTJ BI W/WO BALO/MCHNL DEV 2/> NDLS Interventional Radiology 100
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