Effective: December 9, 2012
Revised:
ATTACHMENT 2 TO FORMATS G99HS, G99IMM, AND G99HC
PHYSICIAN'S CURRENT PROCEDURAL TERMINOLOGY 4th Edition (CPT) CODES
| CPT Code | Description |
| 00120 | Anesthesia for Ear Surgery |
| 01230 | Anesth, Surgery of Femur |
| 10060 | Drainage of Skin Abcess |
| 12001 | Repair Superficial Wound(s) |
| 22899 | Spine Surgery Procedures |
| 29065 | Application of Long Arm Cast |
| 29075 | Application of Forearm Cast |
| 29405 | Apply Short Leg Cast |
| 36430 | Blood Transfusion Service |
| 50760 | Fusion of Ureters |
| 69210 | Remove Impacted Ear Wax |
| 69420 | Incision of Eardrum |
| 69437 | Create Eardrum Openings |
| 70250 | X-ray Exam of Skull |
| 70470 | Contrast CAT Scans of Head |
| 71000 | Minifilm X-ray of Chest |
| 71010 | X-ray Exam of Chest |
| 72110 | X-ray Exam of Lower Spine |
| 73000 | X-ray Exam of Collarbone |
| 73060 | X-ray Exam of Humerus |
| 73090 | X-ray Exam of Forearm |
| 73100 | X-ray Exam of Wrist |
| 73120 | X-ray Exam of Hand |
| 73140 | X-ray Exam of Finger(s) |
| 73560 | X-ray Exam of Lower Leg |
| 73600 | X-ray Exam of Ankle |
| 73620 | X-ray Exam of Foot |
| 81000 | Urinalysis with Microscopy |
| 81002 | Routine Urine Analysis |
| 81005 | Urinalysis |
| 82465 | Assay Serum Cholesterol |
| 82784 | Assay Gammaglobulin A/D/G/M |
| 82947 | Assay Body Fluid, Glucose |
| 82948 | Stick Assay of Blood Glucose |
| 83018 | Chromatograph Screen, Metals |
| 83020 | Assay Hemoglobin |
| 83645 | Test Blood for Lead |
| 85014 | Hematocrit |
| 85018 | Hemoglobin, Colorimetric |
| 85022 | Automated Hemogram |
| 85031 | Manual Hemogram, Complete CBC |
| 86300 | Heterophile Antibody Screen |
| 86580 | TB Patch or Intradermal Test |
| 86585 | TB Tine Test |
| 87060 | Nose/Throat Culture, Bacteria |
| 87070 | Culture Specimen, Bacteria |
| 87072 | Culture Specimen by Kit |
| 87086 | Urine Culture, Colony Count |
| 87177 | Ova and Parasites Smears |
| 90000 | Office Visit, New, Brief |
| 90010 | Office Visit, New, Limited |
| 90015 | Office Visit, New, Intermed. |
| 90017 | Office Visit, New, Extended |
| 90020 | Office Visit, New, Comprrh. |
| 90030 | Office Visit, Minimal |
| 90040 | Office Visit, Brief |
| 90050 | Office Visit, Limited |
| 90060 | Office Visit, Intermed |
| 90070 | Office Visit, Extended |
| 90080 | Office Visit, Compreh. |
| 90100 | Home Visit, New, Brief |
| 90110 | Home Visit, New, Limited |
| 90115 | Home Visit, New, Intermed. |
| 90130 | Home Visit, Minimal |
| 90140 | Home Visit, Brief |
| 90150 | Home Visit, Limited |
| 90160 | Home Visit, Intermed. |
| 90200 | Hospital Care, New, Brief |
| 90215 | Hospital Care, New, Intermed. |
| 90220 | Hospital Care, New Compreh. |
| 90240 | Hospital Visit, Brief |
| 90250 | Hospital Visit, Limited |
| 90260 | Hospital Visit, Intermediate |
| 90270 | Hospital Visit, Extended |
| 90280 | Hospital Visit, Comprehensive |
| 90400 | Care Facility Visit, Brief |
| 90500 | Emergency Care, New, Minimal |
| 90510 | Emergency Care, New, Limited |
| 90600 | Limited Consultation |
| 90699 | General Medical Service |
| 90701 | DTP Immunization |
| 90702 | DT Immunization |
| 90703 | Tetanus Immunization |
| 90704 | Mumps Immunization |
| 90705 | Measles Immunization |
| 90706 | Rubella Immunization |
| 90707 | MMR Virus Immunization |
| 90708 | Measles-Rubella Immunization |
| 90712 | Oral Poliovirus Immunization |
| 90718 | TD Immunization |
| 90728 | BCG Immunization |
| 90749 | Immunization Procedure |
| 90751 | Preventive Health Care, 12-17 |
| 90752 | Preventive Health Care, 5-11 |
| 90753 | Preventive Health Care, 1-4 |
| 90754 | Preventive Health Care, Baby |
| 90755 | Infant Care to Age One Year |
| 90761 | Preventive Health care, 12-17 |
| 90762 | Preventive health Care, 5-11 |
| 90763 | Preventive health Care, 1-4 |
| 90764 | Preventive Health Care, Baby |
| 90774 | Developmental Evaluation Tests |
| 90782 | Injection of Medication |
| 90788 | Injection of Antibiotic |
| 90796 | Intrathecal Chemotherapy |
| 90801 | Diagnostic Interview |
| 90835 | Special Interview |
| 90887 | Consultation with Family |
| 92002 | New Eye Exam & Treatment |
| 92004 | New Eye Exam & Treatment |
| 92012 | Eye Exam & Treatment |
| 92014 | Eye Exam & Treatment |
| 92020 | Special Eye Evaluation |
| 92081 | Visual Field Examination(s) |
| 92265 | Eye Muscle Evaluation |
| 92283 | Color Vision Examination |
| 92340 | Fitting of Spectacles |
| 92370 | Repair & Adjust Spectacles |
| 92390 | Supply of Spectacles |
| 92395 | Supply of Spectacles |
| 92502 | Ear and Throat Examination |
| 92504 | Ear Microscopy Examination |
| 92506 | Speech & Hearing Evaluation |
| 92507 | Speech/Hearing Therapy |
| 92551 | Pure Tone Hearing Test, Air |
| 92552 | Pure Tone Audiometry, Air |
| 92553 | Audiometry, Air & Bone |
| 92556 | Speech Audiometry, Complete |
| 92557 | Comprehensive Audiometry |
| 92565 | Stenger Test, Pure Tone |
| 92566 | Impedance Hearing Test |
| 92567 | Tympanometry |
| 92591 | Hearing Aid Exam, Both Ears |
| 93000 | Electrocardiogram, Complete |
| 93799 | Cardiovascular Procedures |
| 95105 | Allergy Patient Counseling |
| 95819 | Electroencephalogram (EEG) |
| 95881 | Cerebral Developmental Test |
| 99013 | Telephone Consultation |
| 99025 | Initial Surgical Evaluation |
| 99056 | Non-Office Medical Services |
| 99058 | Office Emergency Care |
| 99062 | Emergency Care Services |
| 99070 | Special Supplies |
| 99075 | Medical Testimony |
| 99078 | Group Health Education |
| 99080 | Special Reports or Forms |
| 99090 | Computer Data Analysis |
| 99155 | Conference with Physician |
| 99199 | Special Service or Report |
| D0110 | Initial Dental Exam |
| D0120 | Periodic Dental Exam |
| D0130 | Emergency Dental Exam |
| D0210 | Complete Radiology Series |
| D0220 | 1 Periapical |
| D0230 | Addition Films |
| D0270 | Bitewing - Single Film |
| D0272 | 2 Bitewings |
| D0274 | 4 Bitewings |
| D0330 | Panoramic |
| D0471 | Dental - Diagnostic Photos |
| D1110 | Adult Prophy |
| D1120 | Child Prophy |
| D1220 | Stann. Flu 1 Treat Exc Phoph |
| D1230 | Fluoride Treatment |
| D1330 | Oral Hygiene Instr. |
| D1340 | Training-Prevent-Dental Care |
| D1350 | Enamel Sealants |
| D2110 | Amal. Prim. 1 Surf |
| D2120 | Amal. Prim. 2 Surf |
| D2130 | Amal. Prim. 3 Surf |
| D2131 | Amalgam Deciduous 4 Surfaces |
| D2140 | Amal. Perm. 1 Surf |
| D2150 | Amal. Perm. 2 Surf |
| D2160 | Amal. Perm. 3 Surf |
| D2161 | Amalgam Perm. 4 or More Surf |
| D2310 | Acrylic or Plastic |
| D2330 | Composite 1 Surf |
| D2331 | Composite 2 Surf |
| D2332 | Composite Resin. 3 Surfaces |
| D2335 | Composite Resin |
| D2750 | Crown Porc./Metal |
| D2830 | Stainless Steel |
| D2940 | Sedative Treatment |
| D3110 | Pulp Cap Direct |
| D3120 | Pulp Cap Indirect |
| D3200 | Pulpotomy Exc. Final Restor. |
| D3220 | Vital Pulpotomy |
| D3310 | Root Canal 1 |
| D3330 | Root Canal 3 |
| D4220 | Subging. Curet./Quad |
| D4340 | Perio Scale, Comp |
| D4341 | Perio S. P. |
| D6750 | Porcelain/Metal |
| D7110 | Extraction |
| D7120 | Add. Extr. |
| D9210 | Local Anesthesia |
| D9230 | N202-02 Sedation |
| D9310 | Dental Consultation |