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12/13/2013

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Sections

  • Alcohol Misuse (Screening)
  • Alcohol Misuse (Counseling)
  • Aspirin for the Primary Prevention of Cardiovascular Events (Counseling)
  • Breast Cancer (Screening)
  • Breast Cancer Genetic Risk Assessment and BRCA Mutation Testing (Counseling)
  • Breast Cancer Preventive Medication and Preventive Treatment (Counseling)
  • Breast Cancer (Preventive Medication)
  • Cervical Cancer (Screening)
  • Child Development (Screening)
  • Newborn Hearing (Screening)
  • Newborn Screening for Genetic and Endocrine Disorders (Screening)
  • Contraceptive Use (Counseling)
  • Depression (Screening)
  • Diabetes (Screening)
  • Healthy Diet (Counseling)
  • Breastfeeding (Counseling)
  • Folic Acid Supplementation (Counseling)
  • Group B Streptococcal Disease (Screening)
  • Group B Streptococcal Disease (Preventive Medication)
  • Hepatitis B Virus (HBV) (Screening)
  • Hepatitis B Virus (HBV) (Immunization and Treatment)
  • Preeclampsia (Screening)
  • Rh(D) Incompatibility (Screening)
  • Rubella (Screening)
  • Syphilis (Screening)
  • Tetanus (Immunization)
  • Tobacco Use Treatment (Screening)
  • Hypertension (Screening)
  • Lipid Disorders (Screening)
  • Motor Vehicle-Related Injury Prevention (Counseling)
  • Obesity (Screening)
  • Obesity (Counseling)
  • Osteoporosis (Screening)
  • Counseling to Prevent Sexually Transmitted Infections (STI)
  • Tobacco Use (Screening)
  • Tobacco Use (Counseling)
  • Tobacco Use (Treatment)
  • Tuberculosis (Screening)

CURRENT PROCEDURAL TERMINOLOGY CODES (CPT © CODES

)
Current Procedural Terminology
©

2009 American Medical Association

Abdominal Aortic Aneurysm (Screening) 76700 76705 Abdominal ultrasound, complete Abdominal ultrasound, limited (eg, single organ, quadrant, follow-up)

CURRENT PROCEDURAL TERMINOLOGY CODES (CPT © CODES)
Current Procedural Terminology
©

2009 American Medical Association

Alcohol Misuse (Screening) 99420 H0001* H0049* Administration and interpretation of health risk assessment instrument Alcohol and/or drug assessment Alcohol and other drug screening

Alcohol Misuse (Counseling) 96150-5 98960-2 90804-8 99384 99385 99386 99387 99394 99394 99395 99396 99397 99401 99402 99403 99404 99408 99409 H0050* H0004* Health and behavior assessment and intervention Education and training for patient self-management Psychotherapy, including medical management for some codes Comprehensive preventive services, 12 to 17 years, new patient Comprehensive preventive services, 18 to 39 years, new patient Comprehensive preventive services, 40 to 64 years, new patient Comprehensive preventive services, 65 years and older, new patient Comprehensive preventive services, 12 to 17 years, established patient Comprehensive preventive services, 12 to 17 years, established patient Comprehensive preventive services, 18 to 39 years, established patient Comprehensive preventive services, 40 to 64 years, established patient Comprehensive preventive services, 65 years and older, established patient Preventive counseling, 15 minutes Preventive counseling, approximately 30 minutes Preventive counseling, approximately 45 minutes Preventive counseling, approximately 60 minutes Alcohol abuse structured screening and brief intervention, 15 to 30 minutes Alcohol abuse structured screening and brief intervention, 30 minutes or greater Alcohol and/or Drug Services, Brief Intervention, per 15 minutes Behavioral health counseling, per 15 minutes

*“H” codes are used by Medicaid and other plans in order to identify mental health services such as alcohol and drug screening.

CURRENT PROCEDURAL TERMINOLOGY CODES (CPT © CODES)
Current Procedural Terminology
©

2009 American Medical Association

Aspirin for the Primary Prevention of Cardiovascular Events (Counseling) 99401 99402 99403 99404 Preventive medicine counseling/risk factor reduction, 15 minutes Preventive medicine counseling/risk factor reduction, 30 minutes Preventive medicine counseling/risk factor reduction, 45 minutes Preventive medicine counseling/risk factor reduction, 60 minutes

CURRENT PROCEDURAL TERMINOLOGY CODES (CPT © CODES)
Current Procedural Terminology
©

2009 American Medical Association

Breast Cancer (Screening) 77057 77052 76499 99386 99387 99396 99397 S8075* Screening mammography, bilateral Computer aided detection with further physician review for interpretation, with or without digitization of film radiographic images; screening mammography Electrical impedance scan of the breast, bilateral (risk assessment device for breast cancer) Initial preventive medicine evaluation and management, 40 to 64 years, new patient Initial preventive medicine evaluation and management, 65 years and older Periodic preventive medicine evaluation and management, 40 to 64 years, established patient Periodic preventive medicine evaluation and management, 65 years and older Computer analysis of full-field digital mammogram and further physician review and interpretation, mammography

Breast Cancer Genetic Risk Assessment and BRCA Mutation Testing (Counseling) 99401 99402 99403 99404 Preventive medicine counseling/risk factor reduction, 15 minutes Preventive medicine counseling/risk factor reduction, 30 minutes Preventive medicine counseling/risk factor reduction, 45 minutes Preventive medicine counseling/risk factor reduction, 60 minutes

Breast Cancer Genetic Risk Assessment and BRCA Mutation Testing (Testing) 83890 83891 83892 83893 83894 83896 Molecular diagnostics; molecular isolation or extraction Molecular diagnostics; isolation or extraction of highly purified nucleic acid Molecular diagnostics; enzymatic digestion Molecular diagnostics; dot/slot blot production Molecular diagnostics; separation by gel electrophoresis Molecular diagnostics; nucleic acid probe, each

CURRENT PROCEDURAL TERMINOLOGY CODES (CPT © CODES)
Current Procedural Terminology
©

2009 American Medical Association

83897 83898 83900 83901 83902 83903 83904 83905 83906 83907 83908 83909 83912 88271 88272 S3818* S3819* S3820* S3822*

Molecular diagnostics; nucleic acid transfer Molecular diagnostics; amplification of patient nucleic acid, each nucleic acid sequence Molecular diagnostics; amplification of patient nucleic acid, multiplex, first two nucleic acid sequences Molecular diagnostics; amplification of patient nucleic acid, multiplex, each additional nucleic acid Molecular diagnostics; reverse transcription Molecular diagnostics; mutation scanning by physical properties, single segment, each Molecular diagnostics; mutation identification by sequencing, single segment, each segment Molecular diagnostics; mutation identification by allele specific transcription, single segment, each segment Molecular diagnostics; mutation identification by allele specific translation, single segment, each segment Molecular diagnostics; lysis of cells prior to nucleic acid extraction Molecular diagnostics; signal amplification of patient nucleic acid, each nucleic acid sequence Molecular diagnostics; separation and identification by high resolution technique Molecular diagnostics; interpretation and report Molecular cytogenetics; DNA probe, each Molecular cytogenetics; chromosomal in situ hybridization, analyze 3 – 5 cells Complete gene sequence analysis; BRCA1 gene Complete gene sequence analysis; BRCA2 gene Complete BRCA1 and BRCA2 gene sequence analysis for susceptibility to breast and ovarian cancer Single mutation analysis (in individual with a known BRCA1 or BRCA2 mutation in the family) for susceptibility to breast and ovarian cancer

radical. but excluding pectoralis major muscle Immediate insertion of breast prosthesis following mastectomy Delayed insertion of breast prosthesis following mastectomy Breast reconstruction. with or without pectoralis minor muscle. including pectoral muscles. oral 10 mg Breast Cancer Genetic Risk Assessment and BRCA Mutation Testing (Preventive Treatment) 19301 19302 19303 19304 19305 19306 19307 19340 19342 19357 19361 19364 Mastectomy. including pectoral muscles. simple. axillary and internal mammary lymph nodes Mastectomy. including axillary lymph nodes. subcutaneous Mastectomy. radical. 30 minutes Preventive medicine counseling/risk factor reduction. with or without prosthetic implant Breast reconstruction with free flap . with tissue expander. 45 minutes Preventive medicine counseling/risk factor reduction. including subsequent expansion Breast reconstruction with latissimus dorsi flap. immediate or delayed. partial. partial Mastectomy. 60 minutes Breast Cancer (Preventive Medication) S0187* Tamoxifen citrate. complete Mastectomy.CURRENT PROCEDURAL TERMINOLOGY CODES (CPT © CODES) Current Procedural Terminology © 2009 American Medical Association S3823* Three-mutation BRCA1 and BRCA2 analysis for susceptibility to breast and ovarian cancer in Ashkenazi individuals Breast Cancer Preventive Medication and Preventive Treatment (Counseling) 99401 99402 99403 99404 Preventive medicine counseling/risk factor reduction. axillary lymph nodes Mastectomy. with axillary lymphadenectomy Mastectomy. 15 minutes Preventive medicine counseling/risk factor reduction. modified radical.

and the Centers for Medicare and Medicaid Services (CMS). 45 minutes Preventive medicine counseling/risk factor reduction. single pedicle. including closure of donor site Laparoscopy.CURRENT PROCEDURAL TERMINOLOGY CODES (CPT © CODES) Current Procedural Terminology © 2009 American Medical Association 19366 19367 19368 Breast reconstruction with other technique Breast reconstruction with transverse rectus abdmoninis myocutaneous flap. 60 minutes 19369 58661 58720 58940 99401 99402 99403 99404 *“S” codes are national Permanent Level II HCPCS Codes that are maintained by the HCPCS National Panel. 30 minutes Preventive medicine counseling/risk factor reduction. 15 minutes Preventive medicine counseling/risk factor reduction. Permanent Level II HCPCS Codes provide a standardized coding system that is managed jointly by public and private insurers. These codes can be used by all private and public insurers. unilateral or bilateral Oophorectomy. . surgical. including closure of donor site Breast reconstruction with transverse rectus abdominis myocutaneous flap (TRAM). partial or total. complete or partial. with removal of adnexal structures Salpingo-oophorectomy. unilateral or bilateral Preventive medicine counseling/risk factor reduction. single pedicle. double pedicle. a group comprised of representatives from the Blue Cross/Blue Shield Association (BCBSA). thus providing a stable system for claims processing. with microvascular anastomosis Breast reconstruction with transverse rectus abdmoninis myocutaneous flap. the Health Insurance Association of America (HIAA). including closure of donor site.

cervical or vaginal. cervical or vaginal (Bethesda). cervical or vaginal (Bethesda). cervical or vaginal. screening by automated system and manual rescreening or review under physician supervision 88174 88175 . automated thin layer prep. manual screening and rescreening under physician supervision Cytopathology slides. manual screening and rescreening under physician supervision Cytopathology smears. collected in preservation fluid. screening by automated system under physician supervision Cytopathology. cervical or vaginal. screening by automated system. manual screening and rescreening under physician supervision Cytopathology slides. cervical or vaginal (Bethesda). cervical or vaginal. manual screening and computerassisted rescreening using cell selection and review under physician supervision Cytopathology slides. cervical or vaginal (Bethesda). cervical or vaginal. automated thin layer prep. collected in preservation fluid. cervical or vaginal. cervical or vaginal. requiring interpretation by physician Cytopathology. cervical or vaginal. cervical or vaginal. manual screening under physician supervision Cytopathology slides. automated thin layer prep. manual screening and computer-assisted rescreening under physician supervision Cytopathology slides. automated thin layer prep. cervical or vaginal. screening by automated system with manual rescreening under physician supervision Cytopathology slides. cervical or vaginal. definitive hormonal evaluation Cytopathology slides. cervical or vaginal.CURRENT PROCEDURAL TERMINOLOGY CODES (CPT © CODES) Current Procedural Terminology © 2009 American Medical Association Cervical Cancer (Screening) 88141 88142 88143 88147 88148 88150 88152 88153 88154 88155 88164 88165 88166 88167 Cytopathology. under physician supervision Cytopathology smears. manual screening under physician supervision Cytopathology slides. manual screening and computerassisted rescreening under physician supervision Cytopathology slides. manual screening and computer-assisted rescreening using cell selection and review under physician supervision Cytopathology. manual screening under physician supervision Cytopathology.

Counseling. extended with interpretation and report Initial comprehensive preventive medicine evaluation and management. early childhood (ages 1 to 4). infant (under 1 year). Preventive Medication and Treatment) Child Development (Screening) 96110 96111 99381 99382 99391 99392 Developmental screening. limited with interpretation and report Developmental testing. new patient Periodic comprehensive preventive medicine evaluation and management. early childhood (ages 1 to 4 ).CURRENT PROCEDURAL TERMINOLOGY CODES (CPT © CODES) Current Procedural Terminology © 2009 American Medical Association Childhood Health Promotion (Screening. Immunization. new patient Initial comprehensive preventive medicine evaluation and management. infant (under 1 year). established patient . established patient Periodic comprehensive preventive medicine evaluation and management.

Immunization. Counseling. child . excluding prophylaxis.CURRENT PROCEDURAL TERMINOLOGY CODES (CPT © CODES) Current Procedural Terminology © 2009 American Medical Association Childhood Health Promotion (Screening. Preventive Medication and Treatment) Dental Caries Prevention through Oral Fluoride Supplementation (Preventive Medication) D1201 D1203 Topical application of fluoride. including prophylaxis. child Topical application of fluoride.

Immunization. Counseling. Preventive Medication and Treatment) Elevated Blood Lead Levels (Screening) 83655 Lead .CURRENT PROCEDURAL TERMINOLOGY CODES (CPT © CODES) Current Procedural Terminology © 2009 American Medical Association Childhood Health Promotion (Screening.

Immunization. spun microhematocrit Blood count. hemoglobin (Hgb) . Preventive Medication and Treatment) Iron Deficiency Anemia (Screening) 85013 85014 85018 Blood count.CURRENT PROCEDURAL TERMINOLOGY CODES (CPT © CODES) Current Procedural Terminology © 2009 American Medical Association Childhood Health Promotion (Screening. hematocrit (Hct) Blood count. Counseling.

either transient or distortion products) Evoked otoacoustic emissions. comprehensive or diagnostic evaluation (comparison of transient and/or distortion product otoacoustic emissions at multiple levels and frequencies) . comprehensive Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system. Preventive Medication and Treatment) Newborn Hearing (Screening) 92585 92586 92587 92588 Auditory evoked potentials for evoked response audiometry and/or testing of the central nervous system. limited Evoked otoacoustic emissions. limited (single stimulus level.CURRENT PROCEDURAL TERMINOLOGY CODES (CPT © CODES) Current Procedural Terminology © 2009 American Medical Association Childhood Health Promotion (Screening. Immunization. Counseling.

Preventive Medication and Treatment) Newborn Screening for Genetic and Endocrine Disorders (Screening) Screening for genetic and endocrine disorders is a covered benefit and mandated by most states. Purchasers should refer to their health plan administrators for a list of applicable CPT codes. Immunization. Purchasers should refer to their health plan administrators for a current list of applicable CPT codes. Counseling. Case management is a covered benefit and is provided. as medically necessary. for beneficiaries with complex disorders. Newborn Screening for Genetic and Endocrine Disorders (Treatment) Medications and other forms of treatment used to prevent illness or disability among beneficiaries with genetic or endocrine disorders are covered.CURRENT PROCEDURAL TERMINOLOGY CODES (CPT © CODES) Current Procedural Terminology © 2009 American Medical Association Childhood Health Promotion (Screening. .

bilateral Ophthalmological medical exam and evaluation. Counseling. new patient Ophthalmological medical exam and evaluation. extended exam Visual function screening. quantitative. interpretation and report. comprehensive. comprehensive. new patient Ophthalmological medical exam and evaluation. one or more visits. intermediate. automated or semi-automated bilateral. established patient Ophthalmological medical exam and evaluation. established patient . limited exam Visual field exam. one or more visits. Immunization. intermediate. unilateral or bilateral. unilateral or bilateral. Preventive Medication and Treatment) Vision (Screening) (Child) 92081 92082 92083 99172 99173 99174 92002 92004 92012 92014 Visual field exam. unilateral or bilateral. quantitative Visual acuity screening. intermediate exam Visual field exam.CURRENT PROCEDURAL TERMINOLOGY CODES (CPT © CODES) Current Procedural Terminology © 2009 American Medical Association Childhood Health Promotion (Screening. bilateral Ocular photoscreening.

qualitative. by fecal hemoglobin determination by immunoassay. 1-3 simultaneous determinations . consecutive collected specimens with single determination Blood.CURRENT PROCEDURAL TERMINOLOGY CODES (CPT © CODES) Current Procedural Terminology © 2009 American Medical Association Colorectal Cancer (Screening) 45378 45330 82270 82274 Colonoscopy Sigmoidoscopy. flexible Fecal occult blood for colorectal neoplasm screening. by peroxidase activity. occult.

unilateral or bilateral. with bilateral fallopian tube cannulation to induce occlusion by placement of permanent implants Ligation or transection of fallopian tube(s). surgical. new patient Initial preventive medicine evaluation and management. adolescent (12 to 17 years). established patient Periodic preventive medicine evaluation and management. 40 to 64 years. abdominal or vaginal approach. during same hospitalization (separate procedure) Ligation or transection of fallopian tube(s) when done at the time of cesarean delivery or intra-abdominal surgery (not a separate procedure) (List separately in addition to code for primary procedure) Occlusion of fallopian tube(s) by device (e. band. 18 to 39 years. established patient Periodic preventive medicine evaluation and management. 18 to 39 years. postpartum. 40 to 64 years. new patient Periodic preventive medicine evaluation and management. with occlusion of oviducts by device (e. Falope ring) vaginal or suprapubic approach Laparoscopy. adolescent (12 to 17 years). unilateral or bilateral Ligation or transection of fallopian tube(s). new patient Initial preventive medicine evaluation and management. clip.g.CURRENT PROCEDURAL TERMINOLOGY CODES (CPT © CODES) Current Procedural Terminology © 2009 American Medical Association Contraceptive Use (Counseling) 99384 99385 99386 99394 99395 99396 Initial preventive medicine evaluation and management.. abdominal or vaginal approach. or Falope ring) 58615 58661 58671 .g. band. established patient Contraceptive Use (Preventative Intervention) 11975 58300 58565 58600 58605 58611 Insertion implantable contraceptive capsules IUD insertion Hysteroscopy. clip. with removal of adnexal structures (partial or total oophorectomy and/or salpingectomy) Laparoscopy.

including postoperative semen examination(s) Contraceptive pills for birth control .CURRENT PROCEDURAL TERMINOLOGY CODES (CPT © CODES) Current Procedural Terminology © 2009 American Medical Association 58700 55250 S4993 Salpingectomy. unilateral or bilateral (separate procedure) Vasectomy. unilateral or bilateral (separate procedure). complete or partial.

CURRENT PROCEDURAL TERMINOLOGY CODES (CPT © CODES) Current Procedural Terminology © 2009 American Medical Association Depression (Screening) 99420 Administration and interpretation of health risk assessment instrument .

reagent strip Glucose. established patient . 18 to 39 years. by monitoring device FDA-approved for home use Initial preventive medicine evaluation and management. blood. 18 to 39 years. each additional specimen beyond 3 Glucose.CURRENT PROCEDURAL TERMINOLOGY CODES (CPT © CODES) Current Procedural Terminology © 2009 American Medical Association Diabetes (Screening) 82947 82948 82950 82951 82952 82962 99385 99386 99395 99396 Glucose. blood. blood (except reagent stript) Glucose. new patient Initial preventive medicine evaluation and management. established patient Periodic preventive medicine evaluation and management. post glucose dose Glucose tolerance test. 3 specimens Glucose tolerance test. 40 to 64 years. new patient Periodic preventive medicine evaluation and management. 40 to 64 years.

nonphysician healthcare professional using a standardized curriculum. . dietician visit S9470* *“S” codes are national Permanent Level II HCPCS Codes that are maintained by the HCPCS National Panel. Permanent Level II HCPCS Codes provide a standardized coding system that is managed jointly by public and private insurers. face-to-face with the patient (could include caregiver/family) each 30 minutes. group. These codes can be used by all private and public insurers. individual patient Nutritional counseling. 30 minutes Preventive medicine counseling/risk factor reduction. a group comprised of representatives from the Blue Cross/Blue Shield Association (BCBSA). 45 minutes Preventive medicine counseling/risk factor reduction. 30 minutes Preventive medicine counseling/risk factor reduction. group. individual. thus providing a stable system for claims processing. individual.CURRENT PROCEDURAL TERMINOLOGY CODES (CPT © CODES) Current Procedural Terminology © 2009 American Medical Association Healthy Diet (Counseling) 99402 99403 99411 99412 98960 Preventive medicine counseling/risk factor reduction. the Health Insurance Association of America (HIAA). and the Centers for Medicare and Medicaid Services (CMS). 60 minutes Education and training for patient self-management by a qualified.

15 minutes Preventive medicine counseling/risk factor reduction. 30 minutes Preventive medicine counseling/risk factor reduction. 60 minutes .CURRENT PROCEDURAL TERMINOLOGY CODES (CPT © CODES) Current Procedural Terminology © 2009 American Medical Association Healthy Pregnancy (Screening. Preventive Medication. Testing. 45 minutes Preventive medicine counseling/risk factor reduction. and Treatment) Alcohol Misuse (Screening) 99420 Administration/interpretation health risk assessment instrument Alcohol Misuse (Counseling) 99401 99402 99403 99404 Preventive medicine counseling/risk factor reduction. Counseling.

aerobic isolate. antimicrobial agent. quantitative colony count. each plate . bacterial. with isolation and presumptive identification of isolates. each isolate Culture. bacterial. additional methods required for definitive identification.CURRENT PROCEDURAL TERMINOLOGY CODES (CPT © CODES) Current Procedural Terminology © 2009 American Medical Association Healthy Pregnancy (Screening. Counseling. bacterial. minimum lethal concentration (MLC). and Treatment) Asymptomatic Bacteriuria (Screening) 87077 87086 87088 87187 Culture. Preventive Medication. urine Culture. Testing. microdilution or agar dilution. urine Susceptibility studies.

30 minutes Preventive medicine counseling/risk factor reduction. Testing. face-to-face with the patient (could include caregiver/family) each 30 minutes. 45 minutes Preventive medicine counseling/risk factor reduction. 15 minutes Preventive medicine counseling/risk factor reduction. nonphysician health care professional using a standardized curriculum. and Treatment) Breastfeeding (Counseling) 99401 99402 99403 99404 98960 Preventive medicine counseling/risk factor reduction. Counseling. 60 minutes Education and training for patient self-management by a qualified. Preventive Medication. individual patient .CURRENT PROCEDURAL TERMINOLOGY CODES (CPT © CODES) Current Procedural Terminology © 2009 American Medical Association Healthy Pregnancy (Screening.

15 minutes Preventive medicine counseling/risk factor reduction. 30 minutes Preventive medicine counseling/risk factor reduction. and Treatment) Folic Acid Supplementation (Counseling) 99401 99402 99403 99404 Preventive medicine counseling/risk factor reduction.CURRENT PROCEDURAL TERMINOLOGY CODES (CPT © CODES) Current Procedural Terminology © 2009 American Medical Association Healthy Pregnancy (Screening. Preventive Medication. Testing. Counseling. 45 minutes Preventive medicine counseling/risk factor reduction. 60 minutes Folic Acid Supplementation (Preventive Medication) CPT code not applicable .

screening only Group B Streptococcal Disease (Preventive Medication) CPT code not applicable . Counseling.CURRENT PROCEDURAL TERMINOLOGY CODES (CPT © CODES) Current Procedural Terminology © 2009 American Medical Association Healthy Pregnancy (Screening. Preventive Medication. and Treatment) Group B Streptococcal Disease (Screening) 87081 Culture. pathogenic organisms. presumptive. Testing.

dialysis or immunosuppressed patient dosage (4 dose schedule). prophylactic or diagnostic injection (specify substance or drug). adult dosage. for intramuscular use Hepatitis B vaccine. Preventive Medication.CURRENT PROCEDURAL TERMINOLOGY CODES (CPT © CODES) Current Procedural Terminology © 2009 American Medical Association Healthy Pregnancy (Screening. subcutaneous. dialysis or immunosuppressed patient dosage (3 dose schedule). pediatric/adolescent dosage (3 dose schedule). adolescent (2 dose schedule). for intramuscular use Therapeutic. Testing. one vaccine (single or combination vaccine/toxoid) Hepatitis B vaccine. for intramuscular use Hepatitis B vaccine. subcutaneous or intramuscular . or intramuscular injections). for intramuscular use Hepatitis B immune globulin (HBIg). for intramuscular use Hepatitis B vaccine. human. for intramuscular use Hepatitis B vaccine. intradermal. and Treatment) Hepatitis B Virus (HBV) (Screening) 87340 Hepatitis B surface antigen (HBsAg) Hepatitis B Virus (HBV) (Immunization and Treatment) 90471 90740 90743 90744 90746 90747 90371 96372 Immunization administration (includes percutaneous. Counseling.

CURRENT PROCEDURAL TERMINOLOGY CODES (CPT © CODES) Current Procedural Terminology © 2009 American Medical Association Healthy Pregnancy (Screening. and Treatment) Human Immunodeficiency Virus (HIV) (Screening) 86689 86701 86702 86703 87390 87534 87535 87536 S3645* HTLV or HIV antibody. direct probe technique Infectious agent detection by nucleic acid (DNA or RNA). Testing. a group comprised of representatives from the Blue Cross/Blue Shield Association (BCBSA). injection. . Counseling. thus providing a stable system for claims processing. single assay (use modifier 92 for rapid test) Infectious agent antigen detection by enzyme immunoassay. the Health Insurance Association of America (HIAA). 60 minutes Human Immunodeficiency Virus (HIV) (Preventative Medication) J3485 S0104* Zidovudine. HIV-1. HIV-1. oral. 45 minutes Preventive medicine counseling/risk factor reduction. 15 minutes Preventive medicine counseling/risk factor reduction. 100 mg *“S” codes are national Permanent Level II HCPCS Codes that are maintained by the HCPCS National Panel. 10 mg Zidovudine. 30 minutes Preventive medicine counseling/risk factor reduction. confirmatory test HIV-1 antibody (use modifier 92 for rapid test) HIV-2 antibody (use modifier 92 for rapid test) HIV-1 and HIV-2 antibody. HIV-1 Infectious agent detection by nucleic acid (DNA or RNA). These codes can be used by all private and public insurers. and the Centers for Medicare and Medicaid Services (CMS). quantification HIV antibody testing of oral mucosal transudate Human Immunodeficiency Virus (HIV) (Counseling) 99401 99402 99403 99404 Preventive medicine counseling/risk factor reduction. HIV-1. amplified probe technique Infectious agent detection by nucleic acid (DNA or RNA). Preventive Medication. multi-step method. Permanent Level II HCPCS Codes provide a standardized coding system that is managed jointly by public and private insurers.

split virus. for intramuscular use Influenza virus vaccine. subcutaneous. for intramuscular use Influenza virus vaccine. live. for use in children 6-35 months of age. preservative free. for use in individuals 3 years of age and above. for use in children 6-35 months of age. split virus.CURRENT PROCEDURAL TERMINOLOGY CODES (CPT © CODES) Current Procedural Terminology © 2009 American Medical Association Healthy Pregnancy (Screening. for intramuscular use Influenza virus vaccine. intranasal use . one vaccine (single or combination vaccine/toxoid) Influenza virus vaccine. for use in individuals 3 years and above. Counseling. Testing. preservative free. Preventive Medication. intradermal. for intramuscular use Influenza virus vaccine. split virus. and Treatment) Influenza (Immunization) 90471 90655 90656 90657 90658 90660 Immunization administration (includes percutaneous. split virus. or intramuscular injections).

spun microhematocrit Blood count. hematocrit (Hct) Blood count. hemoglobin (Hgb) . and Treatment) Iron Deficiency Anemia (Screening) 85013 85014 85018 Blood count. Preventive Medication. Counseling. Testing.CURRENT PROCEDURAL TERMINOLOGY CODES (CPT © CODES) Current Procedural Terminology © 2009 American Medical Association Healthy Pregnancy (Screening.

Preventive Medication. Counseling. Testing.CURRENT PROCEDURAL TERMINOLOGY CODES (CPT © CODES) Current Procedural Terminology © 2009 American Medical Association Healthy Pregnancy (Screening. and Treatment) Preeclampsia (Screening) CPT code not applicable .

CURRENT PROCEDURAL TERMINOLOGY CODES (CPT © CODES) Current Procedural Terminology © 2009 American Medical Association Healthy Pregnancy (Screening. fractionation and quantitation Nucleic Acid Probe (each) Nucleic Acid Probe w/Amplication (PCR) DNA Interpretation and Report . Counseling. and Treatment) Prenatal Diagnosis of Chromosomal Abnormalities and Neural Tube Defects (NTDs) (Screening) 82105 82106 84702 84703 86336 83632 59000 76946 59015 76945 59012 76941 89290 89291 Alpha-fetoprotein. less than or equal to 5 embryos Greater than 5 embryos 11100-1 Skin Biopsy 83013 82677 83020 83896 83898 83912 Acetylcholinesterase (ACHE) Quantitative Estriol Hemoglobin Electrophoresis. serum Amniotic fluid Gonadotropin. microtechnique (for pre-implantation genetic diagnosis). oocyte polar body or embryo blastomere. qualitative Inhibin A Lactogen. human placental (HPL) human chorionic somatomammotropin Amniocentesis Ultrasound guidance for amniocentesis Chorionic villus sampling Ultrasound guidance for chorionic villus sampling Cordocentesis Ultrasonic guidance for cordocentesis Biopsy. Preventive Medication. chorionic (hCG). Testing. quantitative Gonadotropin. chorionic (hCG).

Testing. 1 karyotype. 15-20 cells Chromosome analysis. and Treatment) Prenatal Diagnosis of Chromosomal Abnormalities and Neural Tube Defects (NTDs) (Screening) 86316 88230 88233 88235 88237 88239 88245 88248 Cancer Antigen Immunoassay Cell Culture. baseline breakage. once for each probe in the assay) Interphase in situ hybridization. amniotic fluid or chorionic villus. 1Karyotype with banding Chromosome Analysis. count 15-20 cells. Bone Marrow Cell Culture. for ataxia telangiectasia. with banding Chromosomal Analysis. Tissue Cell Culture. Counseling. 20-25 cells Chromosome analysis for breakage syndromes. Additional Karyotype Additional Banding Additional Cells Counted Additional High Resolution Molecular cytogenetics. interpretation and report 88261 88262 88267 88269 88280 88283 88285 88289 88271 88275 88291 . 2 karyotypes. count 20 cells. with banding Chromosome analysis. Amnio/CVS Cell Culture. baseline Sister Chromatid Exchange. Karyotype. each (code applied 5 times. score 50-100 cells.CURRENT PROCEDURAL TERMINOLOGY CODES (CPT © CODES) Current Procedural Terminology © 2009 American Medical Association Healthy Pregnancy (Screening. in situ for amniotic fluid cells. count 100 to 300 cells Molecular cytogenetics. DNA probe. count 15 cells. 5 Cell. 2 karyotypes (eg. Preventive Medication. Fanconi anemia. fragile X) Chromosome Analysis. Solid Tumor Chromosome analysis for breakage syndromes. Lymphocytes Cell Culture.

MLH1 gene Complete mlh1 and mlh2 gene sequence analysis for hereditary nonpolyposis colorectal cancer (HNPCC) genetic testing Single-mutation analysis (in individual with a known MLH1 and MLH2 mutation in the family) for hereditary nonpolyposis colorectal cancer (HNPCC) genetic testing Complete APC gene sequence analysis for susceptibility to familial adenomatous polyposis (FAP) and attenuated FAP Single-mutation analysis (in individual with a known APC mutation in the family) for susceptibility to familial adenomatous polyposis (FAP) and attenuated FAP Complete gene sequence analysis for cystic fibrosis genetic testing Complete gene sequence analysis for hemochromatosis genetic testing DNA analysis for germline mutations of the ret proto-oncogene for susceptibility to multiple endocrine neoplasia type 2 Genetic testing for retinoblastoma Genetic testing for von Hippel-Lindau disease DNA analysis of the F5 gene for susceptibility to Factor V Leiden thrombophilia DNA analysis of the connexin 26 gene (GJB2) for susceptibility to congenital. Testing. Preventive Medication. 60 minutes Complete gene sequence analysis. Counseling. 45 minutes Preventive medicine counseling/risk factor reduction. 30 minutes Preventive medicine counseling/risk factor reduction.CURRENT PROCEDURAL TERMINOLOGY CODES (CPT © CODES) Current Procedural Terminology © 2009 American Medical Association Healthy Pregnancy (Screening. 15 minutes Preventive medicine counseling/risk factor reduction. profound deafness Genetic testing for alpha-thalassemia S3833* S3834* S3835* S3837* S3840* S3841* S3842* S3843* S3844* S3845* . and Treatment) Prenatal Diagnosis of Chromosomal Abnormalities and Neural Tube Defects (NTDs) (Screening) 99401 99402 99403 99404 S3828* S3830* S3831* Preventive medicine counseling/risk factor reduction.

transabdominal approach. transabdominal approach. each additional gestation (List separately in addition to code for primary procedure) Ultrasound. Counseling. and Treatment) Prenatal Diagnosis of Chromosomal Abnormalities and Neural Tube Defects (NTDs) (Screening) S3846* S3847* S3848* S3849* S3850* S3851* S3853* Genetic testing for hemoglobin E beta-thalassemia Genetic testing for Tay-Sachs disease Genetic testing for Gaucher disease Genetic testing for Niemann-Pick disease Genetic testing for sickle cell anemia Genetic testing for Canavan disease Genetic testing for myotonic muscular dystrophy Prenatal Diagnosis of Chromosomal Abnormalities and Neural Tube Defects (NTDs) (Screening) 59000 76946 59015 76945 76801 Amniocentesis Ultrasound guidance for amniocentesis Chorionic villus sampling Ultrasound guidance for chorionic villus sampling Ultrasound. real time with image documentation. pregnant uterus. pregnant uterus. after first trimester (> or = 14 weeks 0 days). pregnant uterus. single or first gestation Ultrasound. Testing. transabdominal approach. Preventive Medication. fetal and maternal evaluation. fetal and maternal evaluation. after first trimester (> or = 14 weeks 0 days). each additional gestation 76802 76805 76810 . real time with image documentation. fetal and maternal evaluation. single or first gestation Ultrasound. first trimester (14 weeks 0 days). fetal and maternal evaluation.CURRENT PROCEDURAL TERMINOLOGY CODES (CPT © CODES) Current Procedural Terminology © 2009 American Medical Association Healthy Pregnancy (Screening. transabdominal approach. real time with image documentation. real time with image documentation. first trimester (14 weeks 0 days). pregnant uterus.

transabdominal approach. without non-stress testing 76812 76815 76816 76817 76818 76819 *“S” codes are national Permanent Level II HCPCS Codes that are maintained by the HCPCS National Panel. single or first gestation Ultrasound. follow-up (e. Testing. pregnant uterus.CURRENT PROCEDURAL TERMINOLOGY CODES (CPT © CODES) Current Procedural Terminology © 2009 American Medical Association Healthy Pregnancy (Screening. real time with image documentation. one or more fetuses Ultrasound. a group comprised of representatives from the Blue Cross/Blue Shield Association (BCBSA). pregnant uterus. thus providing a stable system for claims processing. placental location. fetal position. pregnant uterus. real time with image documentation. real time with image documentation. limited (eg. Preventive Medication. real time with image documentation. These codes can be used by all private and public insurers. per fetus Ultrasound. . Permanent Level II HCPCS Codes provide a standardized coding system that is managed jointly by public and private insurers. the Health Insurance Association of America (HIAA).. Counseling. and the Centers for Medicare and Medicaid Services (CMS). pregnant uterus. fetal and maternal evaluation plus detailed fetal anatomic examination.g. transvaginal Fetal biophysical profile. transabdominal approach. real time image documentation. pregnant uterus. re-evaluation of organ system(s) suspected or confirmed to be abnormal on a previous scan). fetal heart beat. re-evaluation of fetal size by measuring standard growth parameters and amniotic fluid volume. transabdominal approach. and Treatment) Prenatal Diagnosis of Chromosomal Abnormalities and Neural Tube Defects (NTDs) (Screening) 76811 Ultrasound. with non-stress testing Fetal biophysical profile. fetal and maternal evaluation plus detailed fetal anatomic examination. each additional gestation Ultrasound. and/or qualitative amniotic fluid volume).

human. for intravenous use Injection. for intramuscular use Rho(D) immune globulin (RhIgIV). IV push Intravenous infusion. for intramuscular use Rho(D) immune globulin (RhIg). human.CURRENT PROCEDURAL TERMINOLOGY CODES (CPT © CODES) Current Procedural Terminology © 2009 American Medical Association Healthy Pregnancy (Screening. Testing. intramuscular Injection. Rh(D) Rh(D) Incompatibility (Preventive Medication) 90384 90385 90386 96372 96374 96365 96366 Rho(D) immune globulin (RhIg). Preventive Medication. mini-dose. human. and Treatment) Rh(D) Incompatibility (Screening) 86901 Blood typing. up 1 hour Intravenous infusion. each additional hour . full-dose. Counseling.

Counseling. Preventive Medication. Testing.CURRENT PROCEDURAL TERMINOLOGY CODES (CPT © CODES) Current Procedural Terminology © 2009 American Medical Association Healthy Pregnancy (Screening. and Treatment) Rubella (Screening) 86762 Rubella antibody .

immunofluorescence .CURRENT PROCEDURAL TERMINOLOGY CODES (CPT © CODES) Current Procedural Terminology © 2009 American Medical Association Healthy Pregnancy (Screening. quantitative Treponema pallidum. qualitative Syphilis. confirmatory test (e. and Treatment) Syphilis (Screening) 86592 86593 86781 87166 87164 87285 Syphilis. FTA-abs) Dark field examination (without specimen collection) Dark field examination (includes specimen collection) Treponema pallidum antigen. Testing.g.. Preventive Medication. Counseling.

preservation free. intradermal. and Treatment) Tetanus (Immunization) 90471 90703 90714 90718 Immunization administration (includes percutaneous. subcutaneous. Counseling. or intramuscular injections). intramuscular use Tetanus and diphtheria toxoids (Td) adsorbed for use in individuals seven years or older. Testing. one vaccine (single or combination vaccine/toxoid) Tetanus toxoid adsorbed. for use in individuals seven years or older.CURRENT PROCEDURAL TERMINOLOGY CODES (CPT © CODES) Current Procedural Terminology © 2009 American Medical Association Healthy Pregnancy (Screening. for intramuscular use Tetanus and diphtheria toxoids (Td) adsorbed. Preventive Medication. for intramuscular use .

Counseling.CURRENT PROCEDURAL TERMINOLOGY CODES (CPT © CODES) Current Procedural Terminology © 2009 American Medical Association Healthy Pregnancy (Screening. intensive. Permanent Level II HCPCS Codes provide a standardized coding system that is managed jointly by public and private insurers. and Treatment) Tobacco Use Treatment (Screening) 99420 Administration/interpretation health risk assessment instrument Tobacco Use Treatment (Counseling) 99401 99402 99403 99404 99406 99407 99078 S9075* S9453* Preventive medicine counseling/risk factor reduction. intermediate. a group comprised of representatives from the Blue Cross/Blue Shield Association (BCBSA). and the Centers for Medicare and Medicaid Services (CMS). greater than 3 minutes up to 10 minutes Smoking and tobacco use cessation counseling visit. thus providing a stable system for claims processing. Preventive Medication. 15 minutes Preventive medicine counseling/risk factor reduction. Testing. 30 minutes Preventive medicine counseling/risk factor reduction. the Health Insurance Association of America (HIAA). non-physician provider. 60 minutes Smoking and tobacco use cessation counseling visit. per session *“S” codes are national Permanent Level II HCPCS Codes that are maintained by the HCPCS National Panel. . greater than 10 minutes Physician educational services in a group setting Tobacco use treatment Tobacco cessation classes. These codes can be used by all private and public insurers. 45 minutes Preventive medicine counseling/risk factor reduction.

60 minutes . 15 minutes Preventive medicine counseling/risk factor reduction. 30 minutes Preventive medicine counseling/risk factor reduction. Treatment) 99401 99402 99403 99404 Preventive medicine counseling/risk factor reduction.CURRENT PROCEDURAL TERMINOLOGY CODES (CPT © CODES) Current Procedural Terminology © 2009 American Medical Association Hypertension (Screening) CPT code not applicable Hypertension (Counseling. 45 minutes Preventive medicine counseling/risk factor reduction.

Adolescent. human. or partner organizations (e. pediatric/adolescent dosage-3 dose schedule. providers. PRP-D conjugate. intramuscular use Hemophilus influenza b vaccine (Hib). intramuscular use Hemophilus influenza b vaccine (Hib). Human Papilloma virus (HPV) vaccine. Adult) This list is complete and up-to-date as of November 14. human. bivalent. 3 dose schedule. AAFP. human. intravenous use Diphtheria antitoxin.g. types 6.) regarding use of these codes. PRP-OMP conjugate (3 dose schedule). authoritative source Vaccines (Toxoids) 90281 90283 90296 90371 90389 90396 90399 90632 90633 90634 90636 90645 90646 90647 90648 90649 90650 Immune globulin (Ig). HbOC conjugate (4 dose schedule). intramuscular use Unlisted immune globulin Hepatitis A vaccine.. intramuscular use Hemophilus influenza b vaccine (Hib). Please refer to AMA/ CPT publications as the current. for intramuscular use . equine. intramuscular use. 18 (quadrivalent) 3 dose schedule. adult dosage. intramuscular use Hemophilus influenza b vaccine (Hib). intramuscular use Tetanus immune globulin (TIg). AAP. human. adult dosage. human. intramuscular use Hepatitis A vaccine. any route Hepatitis B immune globulin (HBIg).CURRENT PROCEDURAL TERMINOLOGY CODES (CPT © CODES) Current Procedural Terminology © 2009 American Medical Association Immunizations (Child. intramuscular use Human papilloma virus (HPV) vaccine. 18. 11. 2008. Medicaid. intramuscular use Varicella-zoster immune globulin. for booster use only. intramuscular use Hepatitis A vaccine. Please refer to your appropriate state or local agency. etc. types 16. intramuscular use Immune globulin (IgIV). PRP-T conjugate (4 dose schedule). 16. pediatric/adolescent dosage-2 dose schedule. intramuscular use Hepatitis A and hepatitis B (HepA-HepB).

for children 6-35 months of age. 2 dose schedule. haemophilus influenza Type B.CURRENT PROCEDURAL TERMINOLOGY CODES (CPT © CODES) Current Procedural Terminology © 2009 American Medical Association 90655 90656 90657 90658 90660 90669 90680 90681 90696 Influenza virus vaccine. tetanus toxoids. live. for use in individuals 3 years of age and above. subcutaneous use Measles virus vaccine. intranasal use Pneumococcal conjugate vaccine. live. live. split virus. and acellular pertussis vaccine (DTaP). intramuscular use Mumps virus vaccine. live. for oral use Diphtheria. inactivated (DTaP . intramuscular use Tetanus toxoid adsorbed. human. split virus. attenuated. live. tetanus toxoids. intramuscular use Influenza virus vaccine. preservative free. intramuscular use Influenza virus vaccine. pentavalent. live. and whole cell pertussis vaccine (DTP). intramuscular use Diphtheria. live.IPV). intramuscular use Influenza virus vaccine. when administered to children 4 through 6 years of age. and acellular pertussis vaccine. and poliovirus vaccine. for intramuscular use Diphtheria. subcutaneous use Rubella virus vaccine. split virus. split virus. tetanus toxoids. tetanus toxoids. subcutaneous use 90698 90700 90701 90702 90703 90704 90705 90706 90707 . intramuscular use Rotavirus vaccine. subcutaneous use Measles. intramuscular use Diphtheria. acellular pertussis vaccine and poliovirus vaccine. for children under five years. oral use. intramuscular use Diphtheria and tetanus toxoids (DT) adsorbed for use in individuals younger than seven years. polyvalent.Hib . for use in individuals younger than seven years. inactivated (DTaP-IPV). Rotavirus vaccine. intramuscular use Influenza virus vaccine. mumps and rubella virus vaccine (MMR). for use in individuals 3 years of age and above. for children 6-35 months of age. preservative free. 3 dose schedule.

for use in individuals seven years or older. tetanus toxoids. subcutaneous or intramuscular use Meningococcal polysaccharide vaccine (any group(s)). intramuscular use Hepatitis B vaccine. live. Y and W-135 (tetravalent). for subcutaneous injection Hepatitis B vaccine. and whole cell pertussis vaccine and Hemophilus influenza B vaccine (DTP-Hib). intramuscular use Diphtheria. C. diphtheria toxoids and acellular pertussis vaccine (Tdap). live. (any type(s)) (OPV). and acellular pertussis vaccine and Hemophilus influenza B vaccine (DTaP-Hib). Hepatitis B. subcutaneous use Poliovirus vaccine. tetanus toxoids.CURRENT PROCEDURAL TERMINOLOGY CODES (CPT © CODES) Current Procedural Terminology © 2009 American Medical Association 90708 90710 90712 90713 90714 90715 90716 90718 90719 90720 90721 90723 90732 90733 90734 90736 90740 90743 90744 Measles and rubella virus vaccine. intramuscular use . intramuscular use Zoster (shingles) vaccine. intramuscular use Diphtheria toxoid. 23-valent. subcutaneous use Tetanus and diphtheria toxoids (Td) adsorbed for use in individuals seven years or older. intramuscular use Varicella virus vaccine. inactivated (DTaP-HepB-IPV). dialysis or immunosuppressed patient dosage (3 dose schedule). serogroups A. tetanus toxoids. intramuscular use Tetanus. subcutaneous use Meningococcal conjugate vaccine. and varicella vaccine (MMRV). live. adult or immunosuppressed patient dosage. inactivated. adolescent (2 dose schedule). for use in individuals 7 years or older. (IPV). pediatric/adolescent dosage (3 dose schedule). intramuscular use Pneumococcal polysaccharide vaccine. and poliovirus vaccine. intramuscular use Diphtheria. oral use Poliovirus vaccine. intramuscular use Diphtheria. subcutaneous use Measles. intramuscular use Hepatitis B vaccine. acellular pertussis vaccine. subcutaneous or intramuscular use Tetanus and diphtheria toxoids (Td) adsorbed. mumps. preservative free. live. rubella. live.

one vaccine (single or combination vaccine/toxoid) Each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure) Immunization administration by intranasal or oral route. intramuscular use Hepatitis B and Hemophilus influenza b vaccine (HepB-Hib). first injection (single or combination vaccine/toxoid). intradermal. adult dosage. one vaccine (single or combination vaccine/toxoid) Each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure) 90466 90467 90468 90471 90472 90473 90474 . intradermal. or intramuscular injections) when the physician counsels the patient/family. or intramuscular injections). subcutaneous. per day Each additional administration (single or combination vaccine/toxoid). intramuscular use Hepatitis B vaccine. first administration (single or combination vaccine/toxoid). per day Each additional injection (single or combination vaccine/toxoid). dialysis or immunosuppressed patient dosage (4 dose schedule). per day (List separately in addition to code for primary procedure) Immunization administration under 8 years of age (includes intranasal or oral routes of administration) when the physician counsels the patient/family. intramuscular use Unlisted vaccine/toxoid Vaccines (Administration and Counseling) 90465 Immunization administration under 8 years of age (includes percutaneous. subcutaneous. per day (List separately in addition to code for primary procedure) Immunization administration (includes percutaneous.CURRENT PROCEDURAL TERMINOLOGY CODES (CPT © CODES) Current Procedural Terminology © 2009 American Medical Association 90746 90747 90748 90749 Hepatitis B vaccine.

total Lipoprotein. established patient Comprehensive preventive services. 30 minutes Preventive medicine counseling/risk factor reduction. 18 to 39 years. new patient Comprehensive preventive services. 60 minutes Comprehensive preventive services. 40 to 64 years. direct measurement. new patient Comprehensive preventive services. 45 minutes Preventive medicine counseling/risk factor reduction. VLDL cholesterol Lipoprotein. 18 to 39 years. established patient Comprehensive preventive services. direct measurement. high density cholesterol Triglycerides Lipid Disorders (Counseling and Treatment) 99401 99402 99403 99404 99385 99386 99387 99395 99396 99397 Preventive medicine counseling/risk factor reduction. established patient . new patient Comprehensive preventive services. 40 to 64 years. 65 years and older.CURRENT PROCEDURAL TERMINOLOGY CODES (CPT © CODES) Current Procedural Terminology © 2009 American Medical Association Lipid Disorders (Screening) 82465 83721 83719 83718 84478 Cholesterol. 15 minutes Preventive medicine counseling/risk factor reduction. direct measurement. LDL cholesterol Lipoprotein. 65 years and older. serum or whole blood.

60 minutes . 15 minutes Preventive medicine counseling and/or risk factor reduction.CURRENT PROCEDURAL TERMINOLOGY CODES (CPT © CODES) Current Procedural Terminology © 2009 American Medical Association Motor Vehicle-Related Injury Prevention (Counseling) 99401 99402 99403 99404 Preventive medicine counseling and/or risk factor reduction. 30 minutes Preventive medicine counseling and/or risk factor reduction. 45 minutes Preventive medicine counseling and/or risk factor reduction.

nonphysician health care professional using a standardized curriculum. 60 minutes Education and training for patient self-management by a qualified. group. 15 minutes Preventive medicine counseling/risk factor reduction. open. 60 minutes Preventive medicine counseling/risk factor reduction. without gastric bypass. open. other than vertical-banded gastroplasty Gastric restrictive procedure with partial gastrectomy. revision of subcutaneous port component only Gastric restrictive procedure. verticalbanded gastroplasty Gastric restrictive procedure. 45 minutes Preventive medicine counseling/risk factor reduction. with gastric bypass for morbid obesity. for morbid obesity. removal of subcutaneous port component only 43846 43847 43848 43886 43887 . without gastric bypass. of gastric restrictive procedure for morbid obesity. group. with short limb (150 cm or less) Roux-en-Y gastroenterostomy Gastric restrictive procedure. individual. individual. individual. face-to-face with the patient (could include caregiver/family) each 30 minutes. with gastric bypass for morbid obesity. 30 minutes Preventive medicine counseling/risk factor reduction. other than adjustable gastric band Gastric restrictive procedure. individual patient Obesity (Treatment) 43842 43843 43845 Gastric restrictive procedure.CURRENT PROCEDURAL TERMINOLOGY CODES (CPT © CODES) Current Procedural Terminology © 2009 American Medical Association Obesity (Screening) 99420 Administration and interpretation of health risk assessment instrument Obesity (Counseling) 99401 99402 99403 99404 99411 99412 98960 Preventive medicine counseling/risk factor reduction. for morbid obesity. 30 minutes Preventive medicine counseling/risk factor reduction. open. individual. pylorus-preserving duodenoileostomy and ileoileostomy (50 to 100 cm common channel) to limit absorption Gastric restrictive procedure.with small intestine reconstruction to limit absorption Revision.

surgical. with gastric bypass and Roux-en-Y gastroenterostomy Laparoscopy. surgical. gastric restrictive procedure. placement of adjustable gastric band Laparoscopy. removal and replacement of adjustable gastric band component only Laparoscopy. surgical. gastric restrictive procedure. gastric restrictive procedure. open removal and replacement of subcutaneous port component only Laparoscopy. gastric restrictive procedure with gastric bypass and small intestine reconstruction to limit absorption . removal of adjustable gastric band component only Laparoscopy. gastric restrictive procedure. removal of adjustable gastric band and subcutaneous port components Laparoscopy. gastric restrictive procedure. surgical. revision of adjustable gastric band component only Laparoscopy. surgical.CURRENT PROCEDURAL TERMINOLOGY CODES (CPT © CODES) Current Procedural Terminology © 2009 American Medical Association 43888 43770 43771 43772 43773 43774 43644 43645 Gastric restrictive procedure. surgical. surgical. gastric restrictive procedure.

bone mineral density study. peripheral site(s). single photon absorptiometry Bone density (bone mineral content) study. bone mineral density study. photodensitometry. one or more sites Osteoporosis (Treatment) CPT code not applicable . radiogrammetry). appendicular skeleton Dual energy x-ray absorptiometry (DXA). one or more sites. bone density study. one or more sites.CURRENT PROCEDURAL TERMINOLOGY CODES (CPT © CODES) Current Procedural Terminology © 2009 American Medical Association Osteoporosis (Screening) 99420 Administration and interpretation of health risk assessment instrument 77078 77079 77080 77081 77082 77083 76977 78350 78351 Computerized tomography. bone density study. vertebral fracture assessment Radiographic absorptiometry (e. one or more sites. one or more sites. axial skeleton Computerized tomography. one or more sites.g. one or more sites Ultrasound bone density measurement and interpretation. any method Bone density (bone mineral content) study. appendicular skeleton Dual energy x-ray absorptiometry (DXA). dual photon absorptiometry. one or more sites. bone density study. one or more sites. axial skeleton Dual energy x-ray absorptiometry (DXA)..

individual. 60 minutes . individual.CURRENT PROCEDURAL TERMINOLOGY CODES (CPT © CODES) Current Procedural Terminology © 2009 American Medical Association Sexually Transmitted Infections (Screening and Counseling) Counseling to Prevent Sexually Transmitted Infections (STI) 99401 99402 99403 99404 Preventive medicine counseling/risk factor reduction. 30 minutes Preventive medicine counseling/risk factor reduction. 15 minutes Preventive medicine counseling/risk factor reduction. individual. individual. 45 minutes Preventive medicine counseling/risk factor reduction.

CURRENT PROCEDURAL TERMINOLOGY CODES (CPT © CODES) Current Procedural Terminology © 2009 American Medical Association Sexually Transmitted Infections (Screening and Counseling) Chlamydia (Screening) 87270 87320 87110 87810 87490 87491 87492 Infectious agent antigen detection by immunofluorescent technique. Chlamydia trachomatis Infectious agent detection by nucleic acid. amplified probe technique Infectious agent detection by nucleic acid (DNA OR RNA). Chlamydia trachomatis. culture. quantification . Chlamydia trachomatis. Chlamydia trachomatis Chlamydia. Chlamydia trachomatis Infectious agent antigen detection by enzyme immunoassay technique. qualitative or semi-quantitative. direct probe technique Infectious agent detection by nucleic acid. any source Infectious agent detection by immunoassay with direct optical observation. Chlamydia trachomatis.

Neisseria gonorrhoeae. screening only Smear. or cell types Infectious agent detection by nucleic acid (DNA or RNA). pathogenic organisms. Neisseria gonorrhoeae. amplified probe technique Infectious agent detection by nucleic acid (DNA OR RNA). direct probe technique Infectious agent detection by nucleic acid (DNA or RNA). fungi. primary source with interpretation. Gram or Giemsa stain for bacteria. Neisseria gonorrhoeae. presumptive. quantification .CURRENT PROCEDURAL TERMINOLOGY CODES (CPT © CODES) Current Procedural Terminology © 2009 American Medical Association Sexually Transmitted Infections (Screening and Counseling) Gonorrhea (Screening) 87081 87205 87590 87591 87492 Culture.

individual. 15 minutes Preventive medicine counseling/risk factor reduction. individual. individual. HIV-1 Infectious agent detection by nucleic acid (DNA or RNA). 60 minutes . HIV-1. HIV-1. quantification HIV antibody testing of oral mucosal transudate Human Immunodeficiency Virus (HIV) (Counseling) 99401 99402 99403 99404 Preventive medicine counseling/risk factor reduction. 45 minutes Preventive medicine counseling/risk factor reduction. multi-step method. amplified probe technique Infectious agent detection by nucleic acid (DNA or RNA). HIV-1. direct probe technique Infectious agent detection by nucleic acid (DNA or RNA). individual. 30 minutes Preventive medicine counseling/risk factor reduction. single assay (use modifier 92 for rapid test) Infectious agent antigen detection by enzyme immunoassay. confirmatory test HIV-1 antibody (use modifier 92 for rapid test) HIV-2 antibody (use modifier 92 for rapid test) HIV-1 and HIV-2 antibody.CURRENT PROCEDURAL TERMINOLOGY CODES (CPT © CODES) Current Procedural Terminology © 2009 American Medical Association Sexually Transmitted Infections (Screening and Counseling) Human Immunodeficiency Virus (HIV) (Screening) 86689 86701 86702 86703 87390 87534 87535 87536 S3645* HTLV or HIV antibody.

quantitative Antibody.CURRENT PROCEDURAL TERMINOLOGY CODES (CPT © CODES) Current Procedural Terminology © 2009 American Medical Association Sexually Transmitted Infections (Screening and Counseling) Syphilis (Screening) 86592 86593 86781 87166 87164 87285 Syphillis test. immunofluorescence . qualitative Syphilis. treponemal pallidum. confirmatory test Dark field examination (without specimen collection) Dark field examination (includes specimen collection) Treponema pallidum antigen.

CURRENT PROCEDURAL TERMINOLOGY CODES (CPT © CODES) Current Procedural Terminology © 2009 American Medical Association Tobacco Use (Screening) 99420 Administration/interpretation health risk assessment instrument Tobacco Use (Counseling) 99401 99402 99403 99404 99406 99407 99078 S9075* S9453* Preventive medicine counseling/risk factor reduction. per session CPT code not applicable *“S” codes are national Permanent Level II HCPCS Codes that are maintained by the HCPCS National Panel. individual. and the Centers for Medicare and Medicaid Services (CMS). 15 minutes Preventive medicine counseling/risk factor reduction. individual. non-physician provider. These codes can be used by all private and public insurers. individual. 30 minutes Preventive medicine counseling/risk factor reduction. Tobacco Use (Treatment) . the Health Insurance Association of America (HIAA). thus providing a stable system for claims processing. a group comprised of representatives from the Blue Cross/Blue Shield Association (BCBSA). 45 minutes Preventive medicine counseling/risk factor reduction. Permanent Level II HCPCS Codes provide a standardized coding system that is managed jointly by public and private insurers. individual. intermediate. 60 minutes Smoking and tobacco use cessation counseling visit. greater than 10 minutes Physician educational services in a group setting Smoking cessation treatment Tobacco cessation classes. intensive. greater than 3 minutes up to 10 minutes Smoking and tobacco use cessation counseling visit.

two views. minimum of four views Skin test. with isolation and presumptive identification of isolates . mycobacteria) any source. intradermal Tuberculosis test. single view Chest xray. AFB. tubercle or other acid-fast bacilli (eg. TB. complete. cell mediated immunity measurement of gamma interferon antigen response Sputum induction for diagnostic purposes Culture.CURRENT PROCEDURAL TERMINOLOGY CODES (CPT © CODES) Current Procedural Terminology © 2009 American Medical Association Tuberculosis (Screening) 71010 71020 71030 86580 86480 94640 87116 Chest xray. frontal and lateral Chest xray. tuberculosis.

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