Radiology Diagnostic Radiology (Diagnostic Imaging) Head and Neck 70010 70015 70030 70100 70110 70120 70130 70134 70140 70150 70160 70170 70190 70200 70210 Myelography, posterior fossa, radiological supervision and interpretation Cisternography, positive contrast, radiological supervision and interpretation Radiologic examination, eye, for detection of foreign body Radiologic examination, mandible; partial, less than 4 views complete, minimum of 4 views Radiologic examination, mastoids; less than 3 views per side complete, minimum of 3 views per side Radiologic examination, internal auditory meati, complete Radiologic examination, facial bones; less than 3 views complete, minimum of 3 views Radiologic examination, nasal bones, complete, minimum of 3 views Dacryocystography, nasolacrimal duct, radiological supervision and interpretation Radiologic examination; optic foramina orbits, complete, minimum of 4 views Radiologic examination, sinuses, paranasal, less than 3 views70220 70240 70250 70260 70300 70310 70320 70328 70330 70332 70336 70350 70355 70360 70370 70371 70380 70390 Radiologic examination, sinuses, paranasal, complete, minimum of 3 views Radiologic examination, sella turcica Radiologic examination, skull; less than 4 views complete, minimum of 4 views Radiologic examination, teeth; single view partial examination, less than full mouth complete, full mouth Radiologic examination, temporomandibular joint, open and closed mouth; unilateral bilateral ‘Temporomandibular joint arthrography, radiological supervision and interpretation (Do not report 70332 in conjunction with 77002) Magnetic resonance (eg, proton) imaging, temporomandibular joint(s) Cephalogram, orthodontic Orthopantogram (eg, panoramic x-ray) Radiologic examination; neck, soft tissue pharynx or larynx, including fluoroscopy and/or magnification technique Complex dynamic pharyngeal and speech evaluation by cine or video recording (70373 has been deleted. For contrast laryngography, use 76499) (For laryngeal computed tomography, see 70490, 70491, 70492) Radiologic examination, salivary gland for calculus Sialography, radiological supervision and interpretation70450 70460 70470 70480 70481 70482 70486 70487 70488 70490 70491 70492 70496 70498 Computed tomography, head or brain; without contrast material with contrast material(s) without contrast material, followed by contrast material(s) and further sections (To report 3D rendering, see 76376, 76377) Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material with contrast material(s) without contrast material, followed by contrast material(s) and further sections (To report 3D rendering, see 76376, 76377) Computed tomography, maxillofacial area; without contrast material with contrast material(s) without contrast material, followed by contrast material(s) and further sections (To report 3D rendering, see 76376, 76377) Computed tomography, soft tissue neck; without contrast material with contrast material(s) without contrast material followed by contrast material(s) and further sections (To report 3D rendering, see 76376, 76377) (For cervical spine, see 72125, 72126) Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing Computed tomographic angiography, neck, with contrast70540 70542 70543 70544 70545 70546 70547 70548 70549 70551 70552 70553 material(s), including noncontrast images, if performed, and image postprocessing Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) (For head or neck magnetic resonance angiography studies, see 70544-70546, 70547-70549) with contrast material(s) without contrast material(s), followed by contrast material(s) and further sequences (Report 70540-70543 once per imaging session) Magnetic resonance angiography, head; without contrast material(s) with contrast material(s) without contrast material(s), followed by contrast material(s) and further sequences Magnetic resonance angiography, neck; without contrast material(s) with contrast material(s) without contrast material(s), followed by contrast material(s) and further sequences Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material with contrast material(s) without contrast material, followed by contrast material(s) and further sequences (For magnetic spectroscopy, use 76390) Functional MRI involves identification and mapping of stimulation of brain function. When neurofunctional tests are administered by a technologist or other non-physician or non-psychologist, use 70554. When neurofunctional tests are entirely administered by a physicianor psychologist, use 70555. 70554 70555 70557 70558 70559 Chest Magnetic resonance imaging, brain, functional MRI; including test selection and administration of repetitive body part movement and/or visual stimulation, not requiring physician or psychologist administration (Do not report 70554 in conjunction with 96020) requiring physician or psychologist administration of entire neurofunctional testing (Do not report 70555 unless 96020 is performed) (Do not report 70554, 70555 in conjunction with 70551-70553 unless a separate diagnostic MRI is performed) Magnetic resonance (eg, proton) imaging, brain (including brain stem and skull base), during open intracranial procedure (eg, to assess for residual tumor or residual vascular malformation); without contrast material with contrast material(s) without contrast material(s), followed by contrast material(s) and further sequences (For stereotactic biopsy of intracranial lesion with magnetic resonance guidance, use 61751, 70557, 70558, or 70559 may be reported only if a separate report is generated. Report only 1 of the above codes once per operative session. Do not use these codes in conjunction with 61751, 77021, 77022) (For fluoroscopic or ultrasonic guidance for needle placement procedures (eg, biopsy, aspiration, injection, localization device) of the thorax, see 76942, 77002) (71010 has been deleted. To report, use 71045) (71015 has been deleted. To report, use 71045) (71020 has been deleted. To report, use 71046)71045 71046 71047 71048 71100 71101 71110 7UL 71120 71130 71250 71260 71270 (71021 has been deleted. To report, use 71047) (71022 has been deleted. To report, see 71047, 71048) (71023 has been deleted. To report, see 71046, 76000) (71030 has been deleted. To report, use 71048) (71034 has been deleted. To report, see 71048, 76000) (71035 has been deleted. To report, see 71046, 71047, 71048) Radiologic examination, chest; single view 2 views 3 views 4 or more views (For acute abdomen series that includes a single view of the chest and one or more views of the abdomen, use 74022) (For concurrent computer-aided detection [CAD] performed in addition to 71045, 71046, 71047, 71048, use 0174T) (Do not report 71045, 71046, 71047, 71048 in conjunction with 0175T for computer-aided detection [CAD] performed remotely from the primary interpretation) Radiologic examination, ribs, unilateral; 2 views including posteroanterior chest, minimum of 3 views Radiologic examination, ribs, bilateral; 3 views including posteroanterior chest, minimum of 4 views Radiologic examination; sternum, minimum of 2 views sternoclavicular joint or joints, minimum of 3 views Computed tomography, thorax; without contrast material with contrast material(s) without contrast material, followed by contrast material(s) and further sections (For cardiac computed tomography of the heart, see 75571-71275 71550 71551 71552 71555 75574) (To report 3D rendering, see 76376, 76377) Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if performed, and image postprocessing (For coronary artery computed tomographic angiography including calcification score and/or cardiac morphology, use 75574) Magnetic resonance (eg, proton) imaging, chest (eg, for evaluation of hilar and mediastinal lymphadenopathy); without contrast material(s) with contrast material(s) without contrast material(s), followed by contrast material(s) and further sequences (For breast MRI, see 77046, 77047, 77048, 77049) Magnetic resonance angiography, chest (excluding myocardium), with or without contrast material(s) Spine and Pelvis 72020 72040 72050 72052 72070 (72010 has been deleted. To report, use 72082) Radiologic examination, spine, single view, specify level (For a single view that includes the entire thoracic and lumbar spine, use 72081) Radiologic examination, spine, cervical; 2 or 3 views 4or 5 views 6 or more views (72069 has been deleted. To report, see 72081, 72082, 72083, 72084) Radiologic examination, spine; thoracic, 2 views72072 72074 72080 72081 72082 72083 72084 72100 72110 72114 72120 72125 72126 72127 72128 thoracic, 3 views thoracic, minimum of 4 views thoracolumbar junction, minimum of 2 views (For a single view examination of the thoracolumbar junction, use 72020) Radiologic examination, spine, entire thoracic and lumbar, including skull, cervical and sacral spine if performed (eg, scoliosis evaluation); one view 2 or 3 views 4or 5 views minimum of 6 views (72090 has been deleted. To report, see 72081, 72082, 72083, 72084) Radiologic examination, spine, lumbosacral; 2 or 3 views minimum of 4 views complete, including bending views, minimum of 6 views bending views only, 2 or 3 views (Contrast material in CT of spine is either by intrathecal or intravenous injection. For intrathecal injection, use also 61055 or 62284. IV injection of contrast material is part of the CT procedure) Computed tomography, cervical spine; without contrast material with contrast material without contrast material, followed by contrast material(s) and further sections (For intrathecal injection procedure, see 61055, 62284) Computed tomography, thoracic spine; without contrast material72129 72130 72131 72132 72133 72141 72142 72146 72147 72148 72149 72156 with contrast material (For intrathecal injection procedure, see 61055, 62284) without contrast material, followed by contrast material(s) and further sections (For intrathecal injection procedure, see 61055, 62284) Computed tomography, lumbar spine; without contrast material with contrast material without contrast material, followed by contrast material(s) and further sections (For intrathecal injection procedure, see 61055, 62284) (To report 3D rendering, see 76376, 76377) Magnetic resonance (eg, proton) imaging, spinal canal and contents, cervical; without contrast material with contrast material(s) (For cervical spinal canal imaging without contrast material followed by contrast material, use 72156) Magnetic resonance (eg, proton) imaging, spinal canal and contents, thoracic; without contrast material with contrast material(s) (For thoracic spinal canal imaging without contrast material followed by contrast material, use 72157) Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; without contrast material with contrast material(s) (For lumbar spinal canal imaging without contrast material followed by contrast material, use 72158) Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast72157 72158 72159 72170 72190 72191 72192 72193 72194 material(s) and further sequences; cervical thoracic lumbar Magnetic resonance angiography, spinal canal and contents, with or without contrast material(s) Radiologic examination, pelvis; 1 or 2 views complete, minimum of 3 views (For pelvimetry, use 74710) (For a combined computed tomography [CT] or computed tomographic angiography abdomen and pelvis study, see 74174, 74176-74178) Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and image postprocessing (Do not report 72191 in conjunction with 73706 or 75635. For CTA aorto-iliofemoral runoff, use 75635) (Do not report 72191 in conjunction with 74175. For a combined computed tomographic angiography abdomen and pelvis study, use 74174) Computed tomography, pelvis; without contrast material with contrast material(s) without contrast material, followed by contrast material(s) and further sections (For a combined CT abdomen and pelvis study, see 74176- 74178) (To report 3D rendering, see 76376, 76377) (For computed tomographic colonography, diagnostic, see 74261-74262. For computed tomographic colonography, screening, use 74263) (Do not report 72192-72194 in conjunction with 74261-74263)72195 72196 72197 72198 72200 72202 72220 72240 72255 Magnetic resonance (eg, proton) imaging, pelvis; without contrast material(s) with contrast material(s) without contrast material(s), followed by contrast material(s) and further sequences (Do not report 72195, 72196, 72197 in conjunction with 74712, 74713) (For magnetic resonance imaging of a fetus[es], see 74712, 74713) Magnetic resonance angiography, pelvis, with or without contrast material(s) Radiologic examination, sacroiliac joints; less than 3 views 3 or more views Radiologic examination, sacrum and coccyx, minimum of 2 views Myelography, cervical, radiological supervision and interpretation (Do not report 72240 in conjunction with 62284, 62302, 62303, 62304, 62305) (When both 62284 and 72240 are performed by the same physician or other qualified health care professional for cervical myelography, use 62302) (For complete cervical myelography via injection procedure at C1-C2, see 61055, 72240) Myelography, thoracic, radiological supervision and interpretation (Do not report 72255 in conjunction with 62284, 62302, 62303, 62304, 62305) (When both 62284 and 72255 are performed by the same physician or other qualified health care professional for72265 72270 72275 thoracic myelography, use 62303) (For complete thoracic myelography via injection procedure at C1-C2, see 61055, 72255) Myelography, lumbosacral, radiological supervision and interpretation (Do not report 72265 in conjunction with 62284, 62302, 62303, 62304, 62305) (When both 62284 and 72265 are performed by the same physician or other qualified health care professional for lumbosacral myelography, use 62304) (For complete lumbosacral myelography via injection procedure at C1-C2, see 61055, 72265) Myelography, 2 or more regions (eg, lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical), radiological supervision and interpretation (Do not report 72270 in conjunction with 62284, 62302, 62303, 62304, 62305) (When both 62284 and 72270 are performed by the same physician or other qualified health care professional for myelography of 2 or more regions, use 62305) (For complete myelography of 2 or more regions via injection procedure at C1-C2, see 61055, 72270) Epidurography, radiological supervision and interpretation (72275 includes 77003) (For injection procedure, see 62280, 62281, 62282, 62320, 62321, 62322, 62323, 62324, 62325, 62326, 62327, 64479, 64480, 64483, 64484) (Use 72275 only when an epidurogram is performed, images documented, and a formal radiologic report is issued) (Do not report 72275 in conjunction with 22586)72285 72295 Discography, cervical or thoracic, radiological supervision and interpretation Discography, lumbar, radiological supervision and interpretation Upper Extremities 73000 73010 73020 73030 73040 73050 73060 73070 73080 73085 73090 73092 73100 73110 73115 (For stress views, any joint, use 77071) Radiologic examination; clavicle, complete scapula, complete Radiologic examination, shoulder; 1 view complete, minimum of 2 views Radiologic examination, shoulder, arthrography, radiological supervision and interpretation (Do not report 77002 in conjunction with 73040) Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction humerus, minimum of 2 views Radiologic examination, elbow; 2 views complete, minimum of 3 views Radiologic examination, elbow, arthrography, radiological supervision and interpretation (Do not report 77002 in conjunction with 73085) Radiologic examination; forearm, 2 views upper extremity, infant, minimum of 2 views Radiologic examination, wrist; 2 views complete, minimum of 3 views Radiologic examination, wrist, arthrography, radiological supervision and interpretation73120 73130 73140 73200 73201 73202 73206 73218 73219 73220 73221 73222 73223 73225 (Do not report 77002 in conjunction with 73115) Radiologic examination, hand; 2 views minimum of 3 views Radiologic examination, finger(s), minimum of 2 views Computed tomography, upper extremity; without contrast material with contrast material(s) without contrast material, followed by contrast material(s) and further sections (To report 3D rendering, see 76376, 76377) Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if performed, and image postprocessing Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s) with contrast material(s) without contrast material(s), followed by contrast material(s) and further sequences Magnetic resonance (eg, proton) imaging, any joint of upper extremity; without contrast material(s) with contrast material(s) without contrast material(s), followed by contrast material(s) and further sequences Magnetic resonance angiography, upper extremity, with or without contrast material(s) Lower Extremities (For stress views, any joint, use 77071) (73500 has been deleted. To report, use 73501)73501 73502 73503 73521 73522 73523 73525 73551 73552 73560 73562 73564 73565 73580 73590 73592 73600 73610 Radiologic examination, hip, unilateral, with pelvis when performed; 1 view 2-3 views minimum of 4 views (73510 has been deleted. To report, see 73502, 73503) (73520 has been deleted. To report, see 73521, 73522, 73523) Radiologic examination, hips, bilateral, with pelvis when performed; 2 views 3-4 views minimum of 5 views Radiologic examination, hip, arthrography, radiological supervision and interpretation (Do not report 73525 in conjunction with 77002) (73550 has been deleted. To report, see 73551, 73552) Radiologic examination, femur; 1 view minimum 2 views Radiologic examination, knee; 1 or 2 views 3 views complete, 4 or more views both knees, standing, anteroposterior Radiologic examination, knee, arthrography, radiological supervision and interpretation (Do not report 73580 in conjunction with 77002) Radiologic examination; tibia and fibula, 2 views lower extremity, infant, minimum of 2 views Radiologic examination, ankle; 2 views complete, minimum of 3 views73615 73620 73630 73650 73660 73700 73701 73702 73706 73718 73719 73720 73721 73722 73723 73725 Radiologic examination, ankle, arthrography, radiological supervision and interpretation (Do not report 73615 in conjunction with 77002) Radiologic examination, foot; 2 views complete, minimum of 3 views Radiologic examination; calcaneus, minimum of 2 views toe(s), minimum of 2 views Computed tomography, lower extremity; without contrast material with contrast material(s) without contrast material, followed by contrast material(s) and further sections (To report 3D rendering, see 76376, 76377) Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if performed, and image postprocessing (For CTA aorto-iliofemoral runoff, use 75635) Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) with contrast material(s) without contrast material(s), followed by contrast material(s) and further sequences Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material with contrast material(s) without contrast material(s), followed by contrast material(s) and further sequences Magnetic resonance angiography, lower extremity, with or without contrast material(s)Abdomen 74018 74019 74021 74022 74150 74160 74170 74174 74175 (74000 has been deleted. To report, use 74018) (74010 has been deleted. To report, see 74019, 74021) (74020 has been deleted. To report, see 74019, 74021) Radiologic examination, abdomen; 1 view 2 views 3 or more views Radiologic examination, abdomen; complete acute abdomen series, including supine, erect, and/or decubitus views, single view chest Computed tomography, abdomen; without contrast material with contrast material(s) without contrast material, followed by contrast material(s) and further sections (For a combined CT abdomen and pelvis study, see 74176- 74178) (To report 3D rendering, see 76376, 76377) (For computed tomographic colonography, diagnostic, see 74261-74262. For computed tomographic colonography, screening, use 74263) (Do not report 74150-74170 in conjunction with 74261-74263) Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if performed, and image postprocessing (Do not report 74174 in conjunction with 72191, 73706, 74175, 75635, 76376, 76377) (For CTA aorto-iliofemoral runoff, use 75635) Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, andimage postprocessing (Do not report 74175 in conjunction with 73706 or 75635. For CTA aorto-iliofemoral runoff, use 75635) (Do not report 74175 in conjunction with 72191. For a combined computed tomographic angiography abdomen and pelvis study, use 74174) For combinations of CT of the abdomen with CT of the pelvis performed at the same session, use the following table. Do not report more than one CT of the abdomen or CT of the pelvis for any session. Stand Alone Code 74150 74160 74170 CT Abdomen |CTAbdomen |CT Abdomen WO Contrast | W Contrast WO/W Contrast 72192 CT Pelvis WO Contrast 74176 74178 74178 72193 CT Pelvis W Contrast 74178 74177 74178 72194 CT Pelvis WO/W Contrast 74178 74178 74178 74176 74177 74178 Computed tomography, abdomen and pelvis; without contrast material with contrast material(s) without contrast material in one or both body regions, followed by contrast material(s) and further sections in one or both body regions (Do not report 74176-74178 in conjunction with 72192-72194, 74150-74170) (Report 74176, 74177, or 74178 only once per CT abdomen and pelvis examination)74181 74182 74183 74185 74190 Magnetic resonance (eg, proton) imaging, abdomen; without contrast material(s) with contrast material(s) without contrast material(s), followed by with contrast material(s) and further sequences Magnetic resonance angiography, abdomen, with or without contrast material(s) Peritoneogram (eg, after injection of air or contrast), radiological supervision and interpretation (For procedure, use 49400) (For computed tomography, see 72192 or 74150) Gastrointestinal Tract 74210 74220 74230 74235 74240 74241 74245 74246 74247 (For percutaneous placement of gastrostomy tube, use 43246) Radiologic examination; pharynx and/or cervical esophagus esophagus Swallowing function, with cineradiography/videoradiography Removal of foreign body(s), esophageal, with use of balloon catheter, radiological supervision and interpretation (For procedure, use 43499) Radiologic examination, gastrointestinal tract, upper; with or without delayed images, without KUB with or without delayed images, with KUB with small intestine, includes multiple serial images Radiological examination, gastrointestinal tract, upper, air contrast, with specific high density barium, effervescent agent, with or without glucagon; with or without delayed images, without KUB with or without delayed images, with KUB74249 74250 74251 74260 74261 74262 74263 74270 74280 74283 74290 74300 74301 with small intestine follow-through Radiologic examination, small intestine, includes multiple serial images via enteroclysis tube Duodenography, hypotonic Computed tomographic (CT) colonography, diagnostic, including image postprocessing; without contrast material with contrast material(s) including non-contrast images, if performed (Do not report 74261, 74262 in conjunction with 72192-72194, 74150-74170, 74263, 76376, 76377) Computed tomographic (CT) colonography, screening, including image postprocessing (Do not report 74263 in conjunction with 72192-72194, 74150-74170, 74261, 74262, 76376, 76377) Radiologic examination, colon; contrast (eg, barium) enema, with or without KUB air contrast with specific high density barium, with or without glucagon ‘Therapeutic enema, contrast or air, for reduction of intussusception or other intraluminal obstruction (eg, meconium ileus) Cholecystography, oral contrast Cholangiography and/or pancreatography; intraoperative, radiological supervision and interpretation additional set intraoperative, radiological supervision and interpretation (List separately in addition to code for primary procedure) (Use 74301 in conjunction with 74300) (74305 has been deleted. To report, use 47531)74328 74329 74330 74340 74355 74360 74363 (74320 has been deleted. To report, use 47532) (74327 has been deleted. For percutaneous biliary stone extraction, use 47544) Endoscopic catheterization of the biliary ductal system, radiological supervision and interpretation (For procedure, see 43260-43278 as appropriate) Endoscopic catheterization of the pancreatic ductal system, radiological supervision and interpretation (For procedure, see 43260-43278 as appropriate) Combined endoscopic catheterization of the biliary and pancreatic ductal systems, radiological supervision and interpretation (For procedure, see 43260-43278 as appropriate) Introduction of long gastrointestinal tube (eg, Miller-Abbott), including multiple fluoroscopies and images, radiological supervision and interpretation (For tube placement, use 44500) Percutaneous placement of enteroclysis tube, radiological supervision and interpretation Intraluminal dilation of strictures and/or obstructions (eg, esophagus), radiological supervision and interpretation (Do not report 74360 in conjunction with 43213, 43214, 43233) Percutaneous transhepatic dilation of biliary duct stricture with or without placement of stent, radiological supervision and interpretation (For procedure, see 47555, 47556) Urinary Tract 74400 Urography (pyelography), intravenous, with or without KUB,74410 74415 74420 74425 74430 74440 74445 74450 74455 74470 74485 with or without tomography Urography, infusion, drip technique and/or bolus technique; with nephrotomography Urography, retrograde, with or without KUB Urography, antegrade (pyelostogram, nephrostogram, loopogram), radiological supervision and interpretation (Do not report 74425 in conjunction with 50430, 50431, 50432, 50433, 50434, 50435, 50693, 50694, 50695) Cystography, minimum of 3 views, radiological supervision and interpretation Vasography, vesiculography, or epididymography, radiological supervision and interpretation Corpora cavernosography, radiological supervision and interpretation Urethrocystography, retrograde, radiological supervision and interpretation Urethrocystography, voiding, radiological supervision and interpretation Radiologic examination, renal cyst study, translumbar, contrast visualization, radiological supervision and interpretation Dilation of ureter(s) or urethra, radiological supervision and interpretation (Do not report 74485 in conjunction with 50436, 50437) (For dilation of ureter without radiologic guidance, use 52341, 52344) (For change of nephrostomy or pyelostomy tube, use 50435) (For dilation of a nephrostomy tract for endourologic procedure, see 50436, 50437) Gynecological and Obstetrical74710 74712 74713 74740 74742 74775 Heart (For abdomen and pelvis, see 72170-72190, 74018, 74019, 74021, 74022, 74150, 74160, 74170) Pelvimetry, with or without placental localization Magnetic resonance (eg, proton) imaging, fetal, including placental and maternal pelvic imaging when performed; single or first gestation each additional gestation (List separately in addition to code for primary procedure) (Use 74713 in conjunction with 74712) (Do not report 74712, 74713 in conjunction with 72195, 72196, 72197) (If only placenta or maternal pelvis is imaged without fetal imaging, see 72195, 72196, 72197) Hysterosalpingography, radiological supervision and interpretation (or introduction of saline or contrast for hysterosalpingography, see 58340) ‘Transcervical catheterization of fallopian tube, radiological supervision and interpretation (For procedure, use 58345) Perineogram (eg, vaginogram, for sex determination or extent of anomalies) Cardiac magnetic imaging differs from traditional magnetic resonance imaging (MRI) in its ability to provide a physiologic evaluation of cardiac function. Traditional MRI relies on static images to obtain clinical diagnoses based upon anatomic information. Improvement in spatial and temporal resolution has expanded the application from an anatomic test and includes physiologic evaluation of cardiac function. Flow and velocity assessment for valves and intracardiac shunts isperformed in addition to a function and morphologic evaluation. Use 75559 with 75565 to report flow with pharmacologic wall motion stress evaluation without contrast. Use 75563 with 75565 to report flow with pharmacologic perfusion stress with contrast. Cardiac MRI for velocity flow mapping can be reported in conjunction with 75557, 75559, 75561, or 75563. Listed procedures may be performed independently or in the course of overall medical care. If the individual providing these services is also responsible for diagnostic workup and/or follow-up care of the patient, also see appropriate sections. Only one procedure in the series 75557-75563 is appropriately reported per session. Only one add-on code for flow velocity can be reported per session. Cardiac MRI studies may be performed at rest and/or during pharmacologic stress. Therefore, the appropriate stress testing code from the 93015-93018 series should be reported in addition to 75559 or 75563. Cardiac computed tomography (CT) and coronary computed tomographic angiography (CTA) include the axial source images of the pre-contrast, arterial phase sequence, and venous phase sequence (if performed), as well as the two-dimensional and three-dimensional reformatted images resulting from the study, including cine review. Contrast enhanced cardiac CT and coronary CTA codes 75571-75574 include any quantitative assessment when performed as part of the same encounter. Report only one computed tomography heart service per encounter. (For separate injection procedures for vascular radiology, see Surgery section, 36000-36299) (For cardiac catheterization procedures, see 93451-93572) (75552-75556 have been deleted. To report, see 75557, 75559, 75561, 75563, 75565)75557 75559 75561 75563 75565 75571 75572 75573 75574 Cardiac magnetic resonance imaging for morphology and function without contrast material; with stress imaging Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast material(s) and further sequences; with stress imaging (75558, 75560, 75562, 75564 have been deleted. To report flow velocity, use 75565) Cardiac magnetic resonance imaging for velocity flow mapping (List separately in addition to code for primary procedure) (Use 75565 in conjunction with 75557, 75559, 75561, 75563) (Do not report 75557, 75559, 75561, 75563, 75565 in conjunction with 76376, 76377) Computed tomography, heart, without contrast material, with quantitative evaluation of coronary calcium Computed tomography, heart, with contrast material, for evaluation of cardiac structure and morphology (including 3D image postprocessing, assessment of cardiac function, and evaluation of venous structures, if performed) Computed tomography, heart, with contrast material, for evaluation of cardiac structure and morphology in the setting of congenital heart disease (including 3D image postprocessing, assessment of LV cardiac function, RV structure and function and evaluation of venous structures, if performed) Computed tomographic angiography, heart, coronary arteries and bypass grafts (when present), with contrast material, including 3D image postprocessing (including evaluation of cardiac structure and morphology, assessment of cardiac function, and evaluation of venous structures, if performed)Vascular Procedures Aorta and Arteries Selective vascular catheterizations should be coded to include introduction and all lesser order selective catheterizations used in the approach (eg, the description for a selective right middle cerebral artery catheterization includes the introduction and placement catheterization of the right common and internal carotid arteries). Additional second and/or third order arterial catheterizations within the same family of arteries supplied by a single first order artery should be expressed by 36218 or 36248. Additional first order or higher catheterizations in vascular families supplied by a first order vessel different from a previously selected and coded family should be separately coded using the conventions described above. The lower extremity endovascular revascularization codes describing services performed for occlusive disease (37220-37235) include catheterization (36200, 36140, 36245-36248) in the work described by the codes. Catheterization codes are not additionally reported for diagnostic lower extremity angiography when performed through the same access site as the therapy (37220-37235) performed in the same session. However, catheterization for the diagnostic lower extremity angiogram may be reported separately if a different arterial puncture site is necessary. For angiography performed in conjunction with therapeutic transcatheter radiological supervision and interpretation services, see the Radiology Transcatheter Procedures guidelines. Diagnostic angiography (radiological supervision and interpretation) codes should NOT be used with interventional procedures for: 1. Contrast injections, angiography, roadmapping, and/or fluoroscopic guidance for the intervention,2. Vessel measurement, and 3. Post-angioplasty/stent/atherectomy angiography, as this work is captured in the radiological supervision and interpretation code(s). In those therapeutic codes that include radiological supervision and interpretation, this work is captured in the therapeutic code. Diagnostic angiography performed at the time of an interventional procedure is separately reportable if: 1. No prior catheter-based angiographic study is available and a full diagnostic study is performed, and the decision to intervene is based on the diagnostic study, OR 2. A prior study is available, but as documented in the medical record: a. The patient’s condition with respect to the clinical indication has changed since the prior study, OR b. There is inadequate visualization of the anatomy and/or pathology, OR c. There is a clinical change during the procedure that requires new evaluation outside the target area of intervention. Diagnostic angiography performed at a separate sessions from an interventional procedure is separately reported. If diagnostic angiography is necessary, is performed at the same session as the interventional procedure and meets the above criteria, modifier 59 must be appended to the diagnostic radiological supervision and interpretation code(s) to denote that diagnostic work has been done following these guidelines. Diagnostic angiography performed at the time of an interventional procedure is NOT separately reportable if it is specifically included in the interventional code descriptor. (For intravenous procedure, see 36000, 36005-36015, and for intra-arterial procedure, see 36100-36248)75600 75605 75625 75630 75635 75705 75710 75716 75726 (For radiological supervision and interpretation, see 75600- 75893) Aortography, thoracic, without serialography, radiological supervision and interpretation (For supravalvular aortography performed at the time of cardiac catheterization, use 93567, which includes imaging supervision, interpretation, and report) Aortography, thoracic, by serialography, radiological supervision and interpretation (For supravalvular aortography performed at the time of cardiac catheterization, use 93567, which includes imaging supervision, interpretation, and report) Aortography, abdominal, by serialography, radiological supervision and interpretation Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological supervision and interpretation Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast material(s), including noncontrast images, if performed, and image postprocessing (Do not report 75635 in conjunction with 72191, 73706, 74174 or 74175) (75658 has been deleted. To report, use 75710) Angiography, spinal, selective, radiological supervision and interpretation Angiography, extremity, unilateral, radiological supervision and interpretation Angiography, extremity, bilateral, radiological supervision and interpretation Angiography, visceral, selective or supraselective (with or without flush aortogram), radiological supervision and75731 75733 75736 75741 75743 75746 75756 75774 interpretation (For selective angiography, each additional visceral vessel studied after basic examination, use 75774) Angiography, adrenal, unilateral, selective, radiological supervision and interpretation Angiography, adrenal, bilateral, selective, radiological supervision and interpretation Angiography, pelvic, selective or supraselective, radiological supervision and interpretation Angiography, pulmonary, unilateral, selective, radiological supervision and interpretation Angiography, pulmonary, bilateral, selective, radiological supervision and interpretation Angiography, pulmonary, by nonselective catheter or venous injection, radiological supervision and interpretation (For pulmonary angiography by nonselective catheter or venous injection performed at the time of cardiac catheterization, use 93568, which includes imaging supervision, interpretation, and report) Angiography, internal mammary, radiological supervision and interpretation (For internal mammary angiography performed at the time of cardiac catheterization, see 93455, 93457, 93459, 93461, 93564, which include imaging supervision, interpretation, and report) Angiography, selective, each additional vessel studied after basic examination, radiological supervision and interpretation (List separately in addition to code for primary procedure) (Use 75774 in addition to code for specific initial vessel studied) (Do not report 75774 as part of diagnostic angiography of theextracranial and intracranial cervicocerebral vessels. It may be appropriate to report 7574 for diagnostic angiography of upper extremities and other vascular beds performed in the same session) (For angiography, see 75600-75756) (For catheterizations, see codes 36215-36248) (For cardiac catheterization procedures, see 93452-93462, 93531-93533, 93563-93568) (75791 has been deleted. To report, see 36901, 36902, 36903, 36904, 36905, 36906) (For radiological supervision and interpretation of dialysis circuit angiography performed through existing access[es] or catheter-based arterial access, use 36901 with modifier 52) Veins and Lymphatics For venography performed in conjunction with therapeutic transcatheter radiological supervision and interpretation services, see the Radiology Transcatheter Procedures guidelines. Diagnostic venography (radiological supervision and interpretation) codes should NOT be used with interventional procedures for: 1. Contrast injections, venography, roadmapping, and/or fluoroscopic guidance for the intervention, 2. Vessel measurement, and 3. Post-angioplasty/stent venography, as this work is captured in the radiological supervision and interpretation code(s). Diagnostic venography performed at the time of an interventional procedure is separately reportable if: 1. No prior catheter-based venographic study is available and a full diagnostic study is performed, and decision to intervene is based onthe diagnostic study, OR 2. A prior study is available, but as documented in the medical record: a. The patient’s condition with respect to the clinical indication has changed since the prior study, OR b. There is inadequate visualization of the anatomy and/or pathology, OR c. There is a clinical change during the procedure that requires new evaluation outside the target area of intervention. Diagnostic venography performed at a separate setting from an interventional procedure is separately reported. Diagnostic venography performed at the time of an interventional procedure is NOT separately reportable if it is specifically included in the interventional code descriptor. 75801 75803 75805 75807 75809 (For injection procedure for venous system, see 36000-36015, 36400-36510) (For injection procedure for lymphatic system, use 38790) Lymphangiography, extremity only, unilateral, radiological supervision and interpretation Lymphangiography, extremity only, bilateral, radiological supervision and interpretation Lymphangiography, pelvic/abdominal, unilateral, radiological supervision and interpretation Lymphangiography, pelvic/abdominal, bilateral, radiological supervision and interpretation Shuntogram for investigation of previously placed indwelling nonvascular shunt (eg, LeVeen shunt, ventriculoperitoneal shunt, indwelling infusion pump), radiological supervision and interpretation (For procedure, see 49427 or 61070)75810 75820 75822 75825 75827 75831 75833 75840 75842 75860 75870 75872 75880 75885 75887 75889 Splenoportography, radiological supervision and interpretation Venography, extremity, unilateral, radiological supervision and interpretation Venography, extremity, bilateral, radiological supervision and interpretation Venography, caval, inferior, with serialography, radiological supervision and interpretation Venography, caval, superior, with serialography, radiological supervision and interpretation Venography, renal, unilateral, selective, radiological supervision and interpretation Venography, renal, bilateral, selective, radiological supervision and interpretation Venography, adrenal, unilateral, selective, radiological supervision and interpretation Venography, adrenal, bilateral, selective, radiological supervision and interpretation Venography, venous sinus (eg, petrosal and inferior sagittal) or jugular, catheter, radiological supervision and interpretation Venography, superior sagittal sinus, radiological supervision and interpretation Venography, epidural, radiological supervision and interpretation Venography, orbital, radiological supervision and interpretation Percutaneous transhepatic portography with hemodynamic evaluation, radiological supervision and interpretation Percutaneous transhepatic portography without hemodynamic evaluation, radiological supervision and interpretation Hepatic venography, wedged or free, with hemodynamic evaluation, radiological supervision and interpretation75891 Hepatic venography, wedged or free, without hemodynamic evaluation, radiological supervision and interpretation 75893 Venous sampling through catheter, with or without angiography (eg, for parathyroid hormone, renin), radiological supervision and interpretation (For procedure, use 36500) Transcatheter Procedures Therapeutic transcatheter radiological supervision and interpretation code(s) include the following services associated with that intervention: 1. Contrast injections, angiography/venography, roadmapping, and fluoroscopic guidance for the intervention, 2. Vessel measurement, and 3. Completion angiography/venography (except for those uses permitted by 75898). Unless specifically included in the code descriptor, diagnostic angiography/venography performed at the time of transcatheter therapeutic radiological and interpretation service(s) is separately reportable (eg, no prior catheter-based diagnostic angiography/venography study of the target vessel is available, prior diagnostic study is inadequate, patient’s condition with respect to the clinical indication has changed since the prior study or during the intervention). See 75600-75893. Codes 75956 and 75957 include all angiography of the thoracic aorta and its branches for diagnostic imaging prior to deployment of the primary endovascular devices (including all routine components of modular devices), fluoroscopic guidance in the delivery of the endovascular components, and intraprocedural arterial angiography (eg, confirm position, detect endoleak, evaluate runoff).Code 75958 includes the analogous services for placement of each proximal thoracic endovascular extension. Code 75959 includes the analogous services for placement of a distal thoracic endovascular extension(s) placed during a procedure after the primary repair. 75894 75898 75901 75902 ‘Transcatheter therapy, embolization, any method, radiological supervision and interpretation (Do not report 75894 in conjunction with 36475, 36476, 36478, 36479, 37241-37244) (75896 has been deleted. For radiological supervision and interpretation for thrombolysis other than coronary, see 37211, 37212, 37213, 37214. For radiological supervision and interpretation for intracranial arterial administration of pharmacological agent(s) other than for thrombolysis, see 61650, 61651) Angiography through existing catheter for follow-up study for transcatheter therapy, embolization or infusion, other than for thrombolysis (For thrombolysis infusion management other than coronary, see 37211-37214, 61645) (For non-thrombolysis infusion management other than coronary, see 61650, 61651) (Do not report 75898 in conjunction with 37211-37214, 37241-37244, 61645, 61650, 61651) Mechanical removal of pericatheter obstructive material (eg, fibrin sheath) from central venous device via separate venous access, radiologic supervision and interpretation (For procedure, use 36595) (For venous catheterization, see 36010-36012) Mechanical removal of intraluminal (intracatheter) obstructive material from central venous device through device lumen, radiologic supervision and interpretation (For procedure, use 36596)75956 75957 75958 75959 (For venous catheterization, see 36010-36012) (75952, 75953, 75954 have been deleted. To report, see 34701- 34711, 0254T) Endovascular repair of descending thoracic aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption); involving coverage of left subclavian artery origin, initial endoprosthesis plus descending thoracic aortic extension(s), if required, to level of celiac artery origin, radiological supervision and interpretation (For implantation of endovascular graft, use 33880) not involving coverage of left subclavian artery origin, initial endoprosthesis plus descending thoracic aortic extension(s), if required, to level of celiac artery origin, radiological supervision and interpretation (For implantation of endovascular graft, use 33881) Placement of proximal extension prosthesis for endovascular repair of descending thoracic aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption), radiological supervision and interpretation (Report 75958 for each proximal extension) (For implantation of proximal endovascular extension, see 33883, 33884) Placement of distal extension prosthesis(s) (delayed) after endovascular repair of descending thoracic aorta, as needed, to level of celiac origin, radiological supervision and interpretation (Do not report 75959 in conjunction with 75956, 75957) (Report 75959 once, regardless of number of modules deployed) (For implantation of distal endovascular extension, use 33886)75970 75984 (Radiologic supervision for transcatheter placement of stents] is included in the therapeutic service codes) (For removal of a vena cava filter, use 37193) (75962, 75964, 75966, 75968 have been deleted. To report, see 36902, 36905, 37246, 37247) ‘Transcatheter biopsy, radiological supervision and interpretation (For injection procedure only for transcatheter therapy or biopsy, see 36100-36299) (For transcatheter renal and ureteral biopsy, use 52007) (For percutaneous needle biopsy of pancreas, use 48102; of retroperitoneal lymph node or mass, use 49180) (75978 has been deleted. To report, see 36902, 36905, 36907, 37248, 37249) (For radiological supervision and interpretation of transluminal balloon angioplasty within the peripheral and/or central segments of a dialysis circuit performed through the dialysis circuit, see 36902, 36905, 36907) (75980 has been deleted. To report, see 47533, 47534, 47535, 47536, 47537) (75982 has been deleted. To report, see 47533, 47534, 47535, 47536, 47537, 47538, 47539, 47540) Change of percutaneous tube or drainage catheter with contrast monitoring (eg, genitourinary system, abscess), radiological supervision and interpretation (For percutaneous replacement of gastrostomy, duodenostomy, jejunostomy, gastro-jejunostomy, or cecostomy [or other colonic] tube including fluoroscopic imaging guidance, see 49450-49452) (To report exchange of a percutaneous nephrostomy catheter, use 50435)75989 (For percutaneous cholecystostomy, use 47490) (For percutaneous biliary procedures, including radiological supervision and interpretation, see 47531-47544) (For percutaneous nephrostolithotomy or pyelostolithotomy, see 50080, 50081) (For removal and/or replacement of an internally dwelling ureteral stent via a transurethral approach, see 50385-50386) Radiological guidance (ie, fluoroscopy, ultrasound, or computed tomography), for percutaneous drainage (eg, abscess, specimen collection), with placement of catheter, radiological supervision and interpretation (Do not report 75989 in conjunction with 10030, 32554, 32555, 32556, 32557, 47490, 49405, 49406, 49407) Other Procedures 76000 76010 76080 (For computed tomography cerebral perfusion analysis, see Category III code 0042) (For arthrography of shoulder, use 73040; elbow, use 73085; wrist, use 73115; hip, use 73525; knee, use 73580; ankle, use 73615) Fluoroscopy (separate procedure), up to 1 hour physician or other qualified health care professional time (Do not report 76000 in conjunction with 33274, 33275, 33957, 33958, 33959, 33962, 33963, 33964, 051ST, 0516T, 0517T, 0518T, 0519T, 05207) (76001 has been deleted) Radiologic examination from nose to rectum for foreign body, single view, child Radiologic examination, abscess, fistula or sinus tract study, radiological supervision and interpretation (For contrast injection[s] and radiological assessment of76098 76100 76101 76102 76120 76125 76140 76376 gastrostomy, duodenostomy, jejunostomy, gastro-jejunostomy, or cecostomy [or other colonic] tube including fluoroscopic imaging guidance, use 49465) Radiological examination, surgical specimen (Do not report 76098 in conjunction with 19081-19086) Radiologic examination, single plane body section (eg, tomography), other than with urography Radiologic examination, complex motion (ie, hypercycloidal) body section (eg, mastoid polytomography), other than with urography; unilateral bilateral (Do not report 76101, 76102 more than once per day) (For panoramic X-ray, use 70355) (For nephrotomography, use 74415) Cineradiography/videoradiography, except where specifically included Cineradiography/videoradiography to complement routine examination (List separately in addition to code for primary procedure) Consultation on X-ray examination made elsewhere, written, report (2D reformatting is no longer separately reported. To report 3D rendering, see 76376, 76377) 3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality with image postprocessing under concurrent supervision; not requiring image postprocessing on an independent workstation (Use 76376 in conjunction with codes] for base imaging procedure[s]) (Do not report 76376 in conjunction with 31627, 34839,76377 76380 76390 76391 76496 76497 76498 76499 70496, 70498, 70544, 70545, 70546, 70547, 70548, 70549, 71275, 71555, 72159, 72191, 72198, 73206, 73225, 73706, 73725, 74174, 74175, 74185, 74261, 74262, 74263, 75557, 75559, 75561, 75563, 75565, 75571, 75572, 75573, 75574, 75635, 76377, 77046, 77047, 77048, 77049, 77061, 77062, 77063, 78012-78999, 93355, 0523T) requiring image postprocessing on an independent workstation (Use 76377 in conjunction with code(s] for base imaging procedure[s]) (Do not report 76377 in conjunction with 34839, 70496, 70498, 70544, 70545, 70546, 70547, 70548, 70549, 71275, 71555, 72159, 72191, 72198, 73206, 73225, 73706, 73725, 74174, 74175, 74185, 74261, 74262, 74263, 75557, 75559, 75561, 75563, 75565, 75571, 75572, 75573, 75574, 75635, 76376, 77046, 77047, 77048, 77049, 77061, 77062, 77063, 78012-78999, 93355, 05231) (76376, 76377 require concurrent supervision of image postprocessing 3D manipulation of volumetric data set and image rendering) Computed tomography, limited or localized follow-up study Magnetic resonance spectroscopy (For magnetic resonance imaging, use appropriate MRI body site code) Magnetic resonance (eg, vibration) elastography Unlisted fluoroscopic procedure (eg, diagnostic, interventional) Unlisted computed tomography procedure (eg, diagnostic, interventional) Unlisted magnetic resonance procedure (eg, diagnostic, interventional) Unlisted diagnostic radiographic procedureDiagnostic Ultrasound All diagnostic ultrasound examinations require permanently recorded images with measurements, when such measurements are clinically indicated. For those codes whose sole diagnostic goal is a biometric measure (ie, 76514, 76516, and 76519), permanently recorded images are not required. A final, written report should be issued for inclusion in the patient’s medical record. The prescription form for the intraocular lens satisfies the written report requirement for 76519. For those anatomic regions that have “complete” and “limited” ultrasound codes, note the elements that comprise a “complete” exam. The report should contain a description of these elements or the reason that an element could not be visualized (eg, obscured by bowel gas, surgically absent). Tf less than the required elements for a “complete” exam are reported (eg, limited number of organs or limited portion of region evaluated), the “limited” code for that anatomic region should be used once per patient exam session. A “limited” exam of an anatomic region should not be reported for the same exam session as a “complete” exam of that same region. Evaluation of vascular structures using both color and spectral Doppler is separately reportable. To report, see Noninvasive Vascular Diagnostic Studies (93880-93990). However, color Doppler alone, when performed for anatomic structure identification in conjunction with a real-time ultrasound examination, is not reported separately. Ultrasound guidance procedures also require permanently recorded images of the site to be localized, as well as a documented description of the localization process, either separately or within the report of the procedure for which the guidance is utilized. Use of ultrasound, without thorough evaluation of organ(s) or anatomic region, image documentation, and final, written report, isnot separately reportable. Definitions A-mode implies a one-dimensional ultrasonic measurement procedure. M-mode implies a one-dimensional ultrasonic measurement procedure with movement of the trace to record amplitude and velocity of moving echo-producing structures. B-scan implies a two-dimensional ultrasonic scanning procedure with a two-dimensional display. Real-time scan implies a two-dimensional ultrasonic scanning, procedure with display of both two-dimensional structure and motion with time. (To report diagnostic vascular ultrasound studies, see 93880- 93990) (For focused ultrasound ablation treatment of uterine leiomyomata, see Category III codes 0071T, 0072T) Head and Neck 76506 Echoencephalography, real time with image documentation (gray scale) (for determination of ventricular size, delineation of cerebral contents, and detection of fluid masses or other intracranial abnormalities), including A-mode encephalography as secondary component where indicated 76510 Ophthalmic ultrasound, diagnostic; B-scan and quantitative A- scan performed during the same patient encounter 76511 quantitative A-scan only 76512 _B-scan (with or without superimposed non-quantitative A- scan) 76513 anterior segment ultrasound, immersion (water bath) B- scan or high resolution biomicroscopy(For scanning computerized ophthalmic diagnostic imaging of the anterior and posterior segments using technology other than ultrasound, see 92132, 92133, 92134) 76514 corneal pachymetry, unilateral or bilateral (determination of corneal thickness) (Do not report 76514 in conjunction with 0402T) 76516 Ophthalmic biometry by ultrasound echography, A-scan; 76519 with intraocular lens power calculation (For partial coherence interferometry, use 92136) 76529 Ophthalmic ultrasonic foreign body localization 76536 Ultrasound, soft tissues of head and neck (eg, thyroid, parathyroid, parotid), real time with image documentation Chest Code 76641 represents a complete ultrasound examination of the breast. Code 76641 consists of an ultrasound examination of all four quadrants of the breast and the retroareolar region. It also includes ultrasound examination of the axilla, if performed. Code 76642 consists of a focused ultrasound examination of the breast limited to the assessment of one or more, but not all of the elements listed in code 76641. It also includes ultrasound examination of the axilla, if performed. Use of ultrasound, without thorough evaluation of organ(s) or anatomic region, image documentation, and final written report, is not separately reportable. 76604 Ultrasound, chest (includes mediastinum), real time with image documentation 76641 Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; complete 76642 limited(Report 76641, 76642 only once per breast, per session) (For axillary ultrasound only, use 76882) Abdomen and Retroperitoneum A complete ultrasound examination of the abdomen (76700) consists of real time scans of the liver, gall bladder, common bile duct, pancreas, spleen, kidneys, and the upper abdominal aorta and inferior vena cava including any demonstrated abdominal abnormality. A complete ultrasound examination of the retroperitoneum (76770) consists of real time scans of the kidneys, abdominal aorta, common iliac artery origins, and inferior vena cava, including any demonstrated retroperitoneal abnormality. Alternatively, if clinical history suggests urinary tract pathology, complete evaluation of the kidneys and urinary bladder also comprises a complete retroperitoneal ultrasound. Use of ultrasound, without thorough evaluation of organ(s) or anatomic region, image documentation and final, written report, is not separately reportable. 76700 Ultrasound, abdominal, real time with image documentation; complete 76705 _ limited (eg, single organ, quadrant, follow-up) 76706 Ultrasound, abdominal aorta, real time with image documentation, screening study for abdominal aortic aneurysm (AAA) (For ultrasound or duplex ultrasound of the abdominal aorta other than screening, see 76770, 76775, 93978, 93979) 76770 Ultrasound, retroperitoneal (eg, renal, aorta, nodes), real time with image documentation; complete 76775, limited 76776 Ultrasound, transplanted kidney, real time and duplex Dopplerwith image documentation (For ultrasound of transplanted kidney without duplex Doppler, use 76775) (For ultrasound and duplex Doppler of a transplanted kidney, do not report 76776 in conjunction with 93975, 93976) Spinal Canal 76800 Ultrasound, spinal canal and contents Pelvis Obstetrical Codes 76801 and 76802 include determination of the number of gestational sacs and fetuses, gestational sac/fetal measurements appropriate for gestation (younger than 14 weeks 0 days), survey of visible fetal and placental anatomic structure, qualitative assessment of amniotic fluid volume/gestational sac shape and examination of the maternal uterus and adnexa. Codes 76805 and 76810 include determination of number of fetuses and amniotic/chorionic sacs, measurements appropriate for gestational age (older than or equal to 14 weeks 0 days), survey of intracranial/spinal/abdominal anatomy, 4 chambered heart, umbilical cord insertion site, placenta location and amniotic fluid assessment and, when visible, examination of maternal adnexa. Codes 76811 and 76812 include all elements of codes 76805 and 76810 plus detailed anatomic evaluation of the fetal brain/ventricles, face, heart/outflow tracts and chest anatomy, abdominal organ specific anatomy, number/length/architecture of limbs and detailed evaluation of the umbilical cord and placenta and other fetal anatomy as clinically indicated.Report should document the results of the evaluation of each element described above or the reason for non-visualization. Code 76815 represents a focused “quick look” exam limited to the assessment of one or more of the elements listed in code 76815. Code 76816 describes an examination designed to reassess fetal size and interval growth or reevaluate one or more anatomic abnormalities of a fetus previously demonstrated on ultrasound, and should be coded once for each fetus requiring reevaluation using modifier 59 for each fetus after the first. Code 76817 describes a transvaginal obstetric ultrasound performed separately or in addition to one of the transabdominal examinations described above. For transvaginal examinations performed for non- obstetrical purposes, use code 76830. 76801 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14 weeks 0 days), transabdominal approach; single or first gestation (To report first trimester fetal nuchal translucency measurement, use 76813) 76802 _each additional gestation (List separately in addition to code for primary procedure) (Use 76802 in conjunction with 76801) (To report first trimester fetal nuchal translucency measurement, use 76814) 76805 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, after first trimester (> or = 14 weeks 0 days), transabdominal approach; single or first gestation 76810 each additional gestation (List separately in addition to code for primary procedure) (Use 76810 in conjunction with 76805)76811 76812 76813 76814 76815 76816 76817 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal anatomic examination, transabdominal approach; single or first gestation each additional gestation (List separately in addition to code for primary procedure) (Use 76812 in conjunction with 76811) Ultrasound, pregnant uterus, real time with image documentation, first trimester fetal nuchal translucency measurement, transabdominal or transvaginal approach; single or first gestation each additional gestation (List separately in addition to code for primary procedure) (Use 76814 in conjunction with 76813) Ultrasound, pregnant uterus, real time with image documentation, limited (eg, fetal heart beat, placental location, fetal position and/or qualitative amniotic fluid volume), 1 or more fetuses (Use 76815 only once per exam and not per element) (To report first trimester fetal nuchal translucency measurement, see 76813, 76814) Ultrasound, pregnant uterus, real time with image documentation, follow-up (eg, re-evaluation of fetal size by measuring standard growth parameters and amniotic fluid volume, re-evaluation of organ system(s) suspected or confirmed to be abnormal on a previous scan), transabdominal approach, per fetus (Report 76816 with modifier 59 for each additional fetus examined in a multiple pregnancy) Ultrasound, pregnant uterus, real time with image documentation, transvaginal (For non-obstetrical transvaginal ultrasound, use 76830)76818 76819 76820 76821 76825 76826 76827 76828 (If transvaginal examination is done in addition to transabdominal obstetrical ultrasound exam, use 76817 in addition to appropriate transabdominal exam code) Fetal biophysical profile; with non-stress testing without non-stress testing (Fetal biophysical profile assessments for the second and any additional fetuses, should be reported separately by code 76818 or 76819 with the modifier 59 appended) (For amniotic fluid index without non-stress test, use 76815) Doppler velocimetry, fetal; umbilical artery middle cerebral artery Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode recording; follow-up or repeat study Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; complete follow-up or repeat study (To report the use of color mapping, use 93325) Nonobstetrical Code 76856 includes the complete evaluation of the female pelvic anatomy. Elements of this examination include a description and measurements of the uterus and adnexal structures, measurement of the endometrium, measurement of the bladder (when applicable), and a description of any pelvic pathology (eg, ovarian cysts, uterine leiomyomata, free pelvic fluid). Code 76856 is also applicable to a complete evaluation of the male pelvis. Elements of the examination include evaluation and measurement (when applicable) of the urinary bladder, evaluation ofthe prostate and seminal vesicles to the extent that they are visualized transabdominally, and any pelvic pathology (eg, bladder tumor, enlarged prostate, free pelvic fluid, pelvic abscess). Code 76857 represents a focused examination limited to the assessment of one or more elements listed in code 76856 and/or the reevaluation of one or more pelvic abnormalities previously demonstrated on ultrasound. Code 76857, rather than 76770, should be utilized if the urinary bladder alone (ie, not including the kidneys) is imaged, whereas code 51798 should be utilized if a bladder volume or post-void residual measurement is obtained without imaging the bladder. Use of ultrasound, without thorough evaluation of organ(s) or anatomic region, image documentation, and final, written report, is not separately reportable. 76830 Ultrasound, transvaginal (For obstetrical transvaginal ultrasound, use 76817) (If transvaginal examination is done in addition to transabdominal non-obstetrical ultrasound exam, use 76830 in addition to appropriate transabdominal exam code) 76831 Saline infusion sonohysterography (SIS), including color flow Doppler, when performed (For introduction of saline for saline infusion sonohysterography, use 58340) 76856 Ultrasound, pelvic (nonobstetric), real time with image documentation; complete 76857 _ limited or follow-up (eg, for follicles) Genitalia 76870 Ultrasound, scrotum and contents 76872 Ultrasound, transrectal;(Do not report 76872 in conjunction with 45341, 45342, 45391, 45392, 0249, 0421T) 76873 _prostate volume study for brachytherapy treatment planning (separate procedure) Extremities Code 76881 represents a complete evaluation of a specific joint in an extremity. Code 76881 requires ultrasound examination of all of the following joint elements: joint space (eg, effusion), peri-articular soft- tissue structures that surround the joint (ie, muscles, tendons, other soft-tissue structures), and any identifiable abnormality. In some circumstances, additional evaluations such as dynamic imaging or stress maneuvers may be performed as part of the complete evaluation. Code 76881 also requires permanently recorded images and a written report containing a description of each of the required elements or reason that an element(s) could not be visualized (eg, absent secondary to surgery or trauma). When fewer than all of the required elements for a “complete” exam (76881) are performed, report the “limited” code (76882). Code 76882 represents a limited evaluation of a joint or an evaluation of a structure(s) in an extremity other than a joint (eg, soft-tissue mass, fluid collection, or nerve[s]). Limited evaluation of a joint includes assessment of a specific anatomic structure(s) (eg, joint space only [effusion] or tendon, muscle, and/or other soft-tissue structure[s] that surround the joint) that does not assess all of the required elements included in 76881. Code 76882 also requires permanently recorded images and a written report containing a description of each of the elements evaluated. For spectral and color Doppler evaluation of the extremities, use 93925, 93926, 93930, 93931, 93970, or 93971 as appropriate. 76881 Ultrasound, complete joint (ie, joint space and peri-articular76882 76885 76886 soft-tissue structures), real-time with image documentation Ultrasound, limited, joint or other nonvascular extremity structure(s) (eg, joint space, peri-articular tendon[s], muscle[s], nerves], other soft-tissue structure[s], or soft-tissue mass[es]), real-time with image documentation Ultrasound, infant hips, real time with imaging documentation; dynamic (requiring physician or other qualified health care professional manipulation) limited, static (not requiring physician or other qualified health care professional manipulation) Ultrasonic Guidance Procedures 76930 76932 76936 76937 Ultrasonic guidance for pericardiocentesis, imaging supervision and interpretation Ultrasonic guidance for endomyocardial biopsy, imaging supervision and interpretation Ultrasound guided compression repair of arterial pseudoaneurysm or arteriovenous fistulae (includes diagnostic ultrasound evaluation, compression of lesion and imaging) Ultrasound guidance for vascular access requiring ultrasound evaluation of potential access sites, documentation of selected vessel patency, concurrent realtime ultrasound visualization of vascular needle entry, with permanent recording and reporting (List separately in addition to code for primary procedure) (Do not report 76937 in conjunction with 33274, 33275, 36568, 36569, 36572, 36573, 36584, 37191, 37192, 37193, 37760, 37761, 76942) (Do not report 76937 in conjunction with 0505T for ultrasound guidance for vascular access) (If extremity venous non-invasive vascular diagnostic study is performed separate from venous access guidance, see 93970, 93971)76940 76941 76942 76945 76946 76948 76965 Ultrasound guidance for, and monitoring of, parenchymal tissue ablation (Do not report 76940 in conjunction with 20982, 20983, 32994, 32998, 50250, 50542, 76942, 76998) (For ablation, see 47370-47382, 47383, 50592, 50593) Ultrasonic guidance for intrauterine fetal transfusion or cordocentesis, imaging supervision and interpretation (For procedure, see 36460, 59012) Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation (Do not report 76942 in conjunction with 10004, 10005, 10006, 10021, 10030, 19083, 19285, 20604, 20606, 20611, 27096, 32554, 32555, 32556, 32557, 37760, 37761, 43232, 43237, 43242, 45341, 45342, 55874, 64479, 64480, 64483, 64484, 64490, 64491, 64493, 64494, 64495, 76975, 0213T, 0214T, 0215T, 0216T, 0217T, 0218T, 0228T, 02297, 0230T, 0231T, 02321, 0249T, 0481T) (For harvesting, preparation, and injection[s] of platelet rich plasma, use 0232T) Ultrasonic guidance for chorionic villus sampling, imaging supervision and interpretation (For procedure, use 59015) Ultrasonic guidance for amniocentesis, imaging supervision and interpretation Ultrasonic guidance for aspiration of ova, imaging supervision and interpretation (For placement of interstitial device[s] for radiation therapy guidance, see 31627, 32553, 49411, 55876) Ultrasonic guidance for interstitial radioelement applicationOther Procedures 76970 76975 76977 76978 76979 76981 76982 76983 76998 Ultrasound study follow-up (specify) Gastrointestinal endoscopic ultrasound, supervision and interpretation (Do not report 76975 in conjunction with 43231, 43232, 43237, 43238, 43240, 43242, 43259, 44406, 44407, 45341, 45342, 45391, 45392, 76942) Ultrasound bone density measurement and interpretation, peripheral site(s), any method Ultrasound, targeted dynamic microbubble sonographic contrast characterization (non-cardiac); initial lesion each additional lesion with separate injection (List separately in addition to code for primary procedure) (Use 76979 in conjunction with 76978) (Do not report 76978, 76979 in conjunction with 96374) Ultrasound, elastography; parenchyma (eg, organ) first target lesion each additional target lesion (List separately in addition to code for primary procedure) (Use 76983 in conjunction with 76982) (Report 76981 only once per session for evaluation of the same parenchymal organ) (To report shear wave liver elastography without imaging, use 91200) (For evaluation of a parenchymal organ and lesionfs] in the same parenchymal organ at the same session, report only 76981) (Do not report 76983 more than two times per organ) Ultrasonic guidance, intraoperative76999 (Do not report 76998 in conjunction with 36475, 36479, 37760, 37761, 47370, 47371, 47380, 47381, 47382, 02497, 0515T, 0516T, 0517T, 0518T, 0519T, 0520T) (For ultrasound guidance for open and laparoscopic radiofrequency tissue ablation, use 76940) Unlisted ultrasound procedure (eg, diagnostic, interventional) Radiologic Guidance Fluoroscopic Guidance 77001 77002 (Do not report guidance codes 77001, 77002, 77003 for services in which fluoroscopic guidance is included in the descriptor) Fluoroscopic guidance for central venous access device placement, replacement (catheter only or complete), or removal (includes fluoroscopic guidance for vascular access and catheter manipulation, any necessary contrast injections through access site or catheter with related venography radiologic supervision and interpretation, and radiographic documentation of final catheter position) (List separately in addition to code for primary procedure) (Do not report 77001 in conjunction with 33957, 33958, 33959, 33962, 33963, 33964, 36568, 36569, 36572, 36573, 36584, 77002) (If formal extremity venography is performed from separate venous access and separately interpreted, use 36005 and 75820, 75822, 75825, or 75827) Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device) (List separately in addition to code for primary procedure) (See appropriate surgical code for procedure and anatomic location)(Use 77002 in conjunction with 10160, 20206, 20220, 20225, 20520, 20525, 20526, 20550, 20551, 20552, 20553, 20555, 20600, 20605, 20610, 20612, 20615, 21116, 21550, 23350, 24220, 25246, 27093, 27095, 27369, 27648, 32400, 32405, 32553, 36002, 38220, 38221, 38222, 38505, 38794, 41019, 42400, 42405, 47000, 47001, 48102, 49180, 49411, 50200, 50390, 51100, 51101, 51102, 55700, 55876, 60100, 62268, 62269, 64505, 64600, 64605) (77002 is included in all arthrography radiological supervision and interpretation codes. See Administration of Contrast Materialls] introductory guidelines for reporting of arthrography procedures) 77003 Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural or subarachnoid) (List separately in addition to code for primary procedure) (Use 77003 in conjunction with 61050, 61055, 62267, 62270, 62272, 62273, 62280, 62281, 62282, 62284, 64510, 64517, 64520, 64610, 96450) (Do not report 77003 in conjunction with 62320, 62321, 62322, 62323, 62324, 62325, 62326, 62327) Computed Tomography Guidance 77011 Computed tomography guidance for stereotactic localization 77012 Computed tomography guidance for needle placement (eg, biopsy, aspiration, injection, localization device), radiological supervision and interpretation (Do not report 77011, 77012 in conjunction with 22586) (Do not report 77012 in conjunction with 10009, 10010, 10030, 27096, 32554, 32555, 32556, 32557, 64479, 64480, 64483, 64484, 64490, 64491, 64492, 64493, 64494, 64495, 64633, 64634, 64635, 64636, 02327, 0481T) (For harvesting, preparation, and injection[s] of platelet-rich77013 77014 plasma, use 0232T) Computed tomography guidance for, and monitoring of, parenchymal tissue ablation (Do not report 77013 in conjunction with 20982, 20983, 32994, 32998) (For percutaneous ablation, see 47382, 47383, 50592, 50593) Computed tomography guidance for placement of radiation therapy fields (For placement of interstitial device[s] for radiation therapy guidance, see 31627, 32553, 49411, 55876) Magnetic Resonance Imaging Guidance 77021 77022 Magnetic resonance imaging guidance for needle placement (eg, for biopsy, needle aspiration, injection, or placement of localization device) radiological supervision and interpretation (For procedure, see appropriate organ or site) (Do not report 77021 in conjunction with 10011, 10012, 10030, 19085, 19287, 32554, 32555, 32556, 32557, 0232T, 0481) (For harvesting, preparation, and injection[s] of platelet-rich plasma, use 0232T) Magnetic resonance imaging guidance for, and monitoring of, parenchymal tissue ablation (Do not report 77022 in conjunction with 20982, 20983, 32994, 32998, 0071, 0072T) (For percutaneous ablation, see 47382, 47383, 50592, 50593) (For focused ultrasound ablation treatment of uterine leiomyomata, see Category III codes 0071T, 0072T) (To report stereotactic localization guidance for breast biopsy or for placement of breast localization device[s], see 19081, 19283)(To report mammographic guidance for placement of breast localization device[s], use 19281) Breast, Mammography 77046 77047 77048 77049 77053 77054 77061 77062 Magnetic resonance imaging, breast, without contrast material; unilateral bilateral Magnetic resonance imaging, breast, without and with contrast material(s), including computer-aided detection (CAD real- time lesion detection, characterization and pharmacokinetic analysis), when performed; unilateral bilateral (77051 has been deleted. To report, see 77065, 77066) (77052 has been deleted. To report, use 77067) Mammary ductogram or galactogram, single duct, radiological supervision and interpretation (For mammary ductogram or galactogram injection, use 19030) Mammary ductogram or galactogram, multiple ducts, radiological supervision and interpretation (77055 has been deleted. To report, use 77065) (77056 has been deleted. To report, use 77066) (77057 has been deleted. To report, use 77067) (77058 has been deleted. To report, see 77046, 77048) (77059 has been deleted. To report, see 77047, 77049) Digital breast tomosynthesis; unilateral bilateral (Do not report 77061, 77062 in conjunction with 76376,77063 77065 77066 77067 76377, 77067) Screening digital breast tomosynthesis, bilateral (List separately in addition to code for primary procedure) (Do not report 77063 in conjunction with 76376, 76377, 77065, 77066) (Use 77063 in conjunction with 77067) Diagnostic mammography, including computer-aided detection (CAD) when performed; unilateral bilateral Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed (For electrical impedance breast scan, use 76499) Bone/Joint Studies 77071 77072 77073 77074 77075 77076 77077 77078 Manual application of stress performed by physician or other qualified health care professional for joint radiography, including contralateral joint if indicated (For radiographic interpretation of stressed images, see appropriate anatomic site and number of views) Bone age studies Bone length studies (orthoroentgenogram, scanogram) Radiologic examination, osseous survey; limited (eg, for metastases) complete (axial and appendicular skeleton) Radiologic examination, osseous survey, infant Joint survey, single view, 2 or more joints (specify) Computed tomography, bone mineral density study, 1 or more sites, axial skeleton (eg, hips, pelvis, spine)77080 Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine) (Do not report 77080 in conjunction with 77085, 77086) 77081 —_appendicular skeleton (peripheral) (eg, radius, wrist, heel) (For dual energy x-ray absorptiometry [DXA] body composition study, use 76499) 77085 _axial skeleton (eg, hips, pelvis, spine), including vertebral fracture assessment (Do not report 77085 in conjunction with 77080, 77086) 77086 Vertebral fracture assessment via dual-energy X-ray absorptiometry (DXA) (Do not report 77086 in conjunction with 77080, 77085) 77084 Magnetic resonance (eg, proton) imaging, bone marrow blood supply 77085 Code is out of numerical sequence. See 77080-77261 77086 Code is out of numerical sequence. See 77080-77261 Radiation Oncology Listings for Radiation Oncology provide for teletherapy and brachytherapy to include initial consultation, clinical treatment planning, simulation, medical radiation physics, dosimetry, treatment devices, special services, and clinical treatment management procedures. They include normal follow-up care during course of treatment and for three months following its completion. When a service or procedure is provided that is not listed in this edition of the CPT codebook it should be identified by a Special Report (see page 309) and one of the following unlisted procedure codes: 77299 Unlisted procedure, therapeutic radiology clinical treatmentplanning 77399 Unlisted procedure, medical radiation physics, dosimetry and treatment devices, and special services 77499 Unlisted procedure, therapeutic radiology treatment management 77799 Unlisted procedure, clinical brachytherapy For treatment by injectable or ingestible isotopes, see subsection Nuclear Medicine. Consultation: Clinical Management Preliminary consultation, evaluation of patient prior to decision to treat, or full medical care (in addition to treatment management) when provided by the therapeutic radiologist may be identified by the appropriate procedure codes from Evaluation and Management, Medicine, or Surgery sections. Clinical Treatment Planning (External and Internal Sources) The clinical treatment planning process is a complex service including interpretation of special testing, tumor localization, treatment volume determination, treatment time/dosage determination, choice of treatment modality, determination of number and size of treatment ports, selection of appropriate treatment devices, and other procedures. Definitions Simple planning requires a single treatment area of interest encompassed in a single port or simple parallel opposed ports with simple or no blocking. Intermediate planning requires 3 or more converging ports, 2 separatetreatment areas, multiple blocks, or special time dose constraints. Complex planning requires highly complex blocking, custom shielding blocks, tangential ports, special wedges or compensators, three or more separate treatment areas, rotational or special beam considerations, combination of therapeutic modalities. 77261 Therapeutic radiology treatment planning; simple 77262 intermediate 77263 complex Simulation is the process of defining relevant normal and abnormal target anatomy, and acquiring the images and data necessary to develop the optimal radiation treatment process for the patient. A. simulation is defined as complex if any of these criteria are met: particle, rotation or arc therapy, complex or custom blocking, brachytherapy simulation, hyperthermia probe verification, or any use of contrast material. If a simulation does not meet any of these criteria, the complexity is defined by the number of treatment areas: one treatment area is simple, two treatment areas are intermediate, and three or more treatment areas are complex. A treatment area is a contiguous anatomic location that will be treated with radiation therapy. Generally, this includes the primary tumor organ or the resection bed and the draining lymph node chains, if indicated. An example is a breast cancer patient for whom a single treatment area could be the breast alone or the breast, adjacent supraclavicular fossa, and internal mammary nodes. In some cases, a patient might receive radiation therapy to more than one discontinuous anatomic location. An example would be a patient with multiple bone metastases in separate sites (eg, femur and cervical spine); in this case, each distinct and separate anatomic site to be irradiated is a separate treatment area. DefinitionsSimple: simulation of a single treatment area. Intermediate: two separate treatment areas. Complex: three or more treatment areas, or any number of treatment areas if any of the following are involved: particle, rotation or arc therapy, complex blocking, custom shielding blocks, brachytherapy simulation, hyperthermia probe verification, any use of contrast materials. 77280 77285 77290 77293 77295 77299 ‘Therapeutic radiology simulation-aided field setting; simple intermediate complex Respiratory motion management simulation (List separately in addition to code for primary procedure) (Use 77293 in conjunction with 77295, 77301) Code is out of numerical sequence. See 77293-77301 Unlisted procedure, therapeutic radiology clinical treatment planning Medical Radiation Physics, Dosimetry, Treatment Devices, and Special Services 77295 77300 77301 3-dimensional radiotherapy plan, including dose-volume histograms Basic radiation dosimetry calculation, central axis depth dose calculation, TDE, NSD, gap calculation, off axis factor, tissue inhomogeneity factors, calculation of non-ionizing radiation surface and depth dose, as required during course of treatment, only when prescribed by the treating physician (Do not report 77300 in conjunction with 77306, 77307, 77316, 77317, 77318, 77321, 77767, 77768, 77770, 77771, 77772, 0394T, 03957) Intensity modulated radiotherapy plan, including dose-volume77306 77307 77316 77317 77318 T7321 histograms for target and critical structure partial tolerance specifications (Dose plan is optimized using inverse or forward planning technique for modulated beam delivery [eg, binary, dynamic MLC] to create highly conformal dose distribution. Computer plan distribution must be verified for positional accuracy based on dosimetric verification of the intensity map with verification of treatment set-up and interpretation of verification methodology) Teletherapy isodose plan; simple (1 or 2 unmodified ports directed to a single area of interest), includes basic dosimetry calculation(s) complex (multiple treatment areas, tangential ports, the use of wedges, blocking, rotational beam, or special beam considerations), includes basic dosimetry calculation(s) (Only 1 teletherapy isodose plan may be reported for a given course of therapy to a specific treatment area) (Do not report 77306, 77307 in conjunction with 77300) Brachytherapy isodose plan; simple (calculation{s] made from 1 to 4 sources, or remote afterloading brachytherapy, 1 channel), includes basic dosimetry calculation(s) (For definition of source, see clinical brachytherapy introductory guidelines) intermediate (calculation[s] made from 5 to 10 sources, or remote afterloading brachytherapy, 2-12 channels), includes basic dosimetry calculation(s) complex (calculation[s] made from over 10 sources, or remote afterloading brachytherapy, over 12 channels), includes basic dosimetry calculation(s) (Do not report 77316, 77317, 77318 in conjunction with 77300) Special teletherapy port plan, particles, hemibody, total body77331 77332 77333 77334 77336 77338 77370 Special dosimetry (eg, TLD, microdosimetry) (specify), only when prescribed by the treating physician ‘Treatment devices, design and construction; simple (simple block, simple bolus) intermediate (multiple blocks, stents, bite blocks, special bolus) complex (irregular blocks, special shields, compensators, wedges, molds or casts) Continuing medical physics consultation, including assessment of treatment parameters, quality assurance of dose delivery, and review of patient treatment documentation in support of the radiation oncologist, reported per week of therapy Multi-leaf collimator (MLC) device(s) for intensity modulated radiation therapy (IMRT), design and construction per IMRT plan (Do not report 77338 in conjunction with 77385 for compensator based IMRT) (Do not report 77338 more than once per IMRT plan) (For immobilization in IMRT treatment, see 77332-77334) Special medical radiation physics consultation Stereotactic Radiation Treatment Delivery 77371 77372 77373 Radiation treatment delivery, stereotactic radiosurgery (SRS), complete course of treatment of cranial lesion(s) consisting of 1 session; multi-source Cobalt 60 based linear accelerator based (For radiation treatment management, use 77432) Stereotactic body radiation therapy, treatment delivery, per fraction to 1 or more lesions, including image guidance, entire course not to exceed 5 fractions (Do not report 77373 in conjunction with 77385, 77386,77401, 77402, 77407, 77412) (or single fraction cranial lesion|s], see 77371, 77372) 77385 Code is out of numerical sequence. See 77412-77427 77386 Code is out of numerical sequence. See 77412-77427 77387 Code is out of numerical sequence. See 77412-77427 Other Procedures 77399 Unlisted procedure, medical radiation physics, dosimetry and treatment devices, and special services Radiation Treatment Delivery Following dosimetry calculations, there are a number of alternative methods to deliver external radiation treatments, which are described with specific CPT codes: m X-ray (photon), including conventional and intensity modulated radiation therapy (IMRT) beams; @ Electron beams; @ Neutron beams; @ Proton beams. All treatment delivery codes are reported once per treatment session. The treatment delivery codes recognize technical-only services and contain no physician work (the professional component). In contrast, the treatment management codes contain only the professional component. Radiation treatment delivery with conventional X-ray or electron beams is assigned levels of complexity based on the number of treatment sites and complexity of the treatment fields, blocking, wedges, and physical or virtual tissue compensators. A simple block is straight-edged or an approximation of a straight edge created by amultileaf collimator (MLC). Energy of the megavoltage (1 MeV) beam does not contribute to complexity. Techniques such as treating a field-in-field to ensure dose homogeneity reflect added complexity. Energies below the megavoltage range may be used in the treatment of skin lesions. Superficial radiation energies (up to 200 kV) may be generated by a variety of technologies and should not be reported with megavoltage (77402, 77407, 77412) for surface application. Do not report clinical treatment planning (77261, 77262, 77263), treatment devices (77332, 77333, 77334), isodose planning (77306, 77307, 77316, 77317, 77318), physics consultation (77336), or radiation treatment management (77427, 77431, 77432, 77435, 77469, 77470, 77499) with 77401, 0394T, or 0395T. When reporting 77401 alone, evaluation and management, when performed, may be reported with the appropriate E/M codes. Intensity modulated radiation therapy (IMRT) uses computer-based optimization techniques with non-uniform radiation beam intensities to create highly conformal dose distributions that can be delivered by a radiotherapy treatment machine. A number of technologies, including spatially and temporally modulated beams, cylindrical beamlets, dynamic MLC, single or multiple fields or arcs, or compensators, may be used to generate IMRT. The complexity of IMRT may vary depending on the area being treated or the technique being used. Image guided radiation therapy (IGRT) may be used to direct the radiation beam and to reflect motion during treatment. A variety of techniques may be used to perform this guidance including imaging (eg, ultrasound, CT, MRI, stereoscopic imaging) and non-imaging (eg, electromagnetic or infrared) techniques. Guidance may be used with any radiation treatment delivery technique and is typically used with IMRT delivery. IMRT delivery codes include the technical component of guidance or tracking, if performed. Because only the technical portion of IGRT is bundled into IMRT, the physician involvement inguidance or tracking may be reported separately. When guidance is required with conventional radiation treatment delivery, both the professional and technical components are reported because neither component of guidance is bundled into conventional radiation treatment delivery services. The technical and professional components of guidance are handled differently with each radiation delivery code depending on the type of radiation being administered. The Radiation Management and Treatment Table is provided for clarity. Definitions Radiation Treatment Delivery, megavoltage (> 1 MeV), any energy Simple: All of the following criteria are met (and none of the complex or intermediate criteria are met): single treatment area, one or two ports, and two or fewer simple blocks. Intermediate: Any of the following criteria are met (and none of the complex criteria are met): 2 separate treatment areas, 3 or more ports on a single treatment area, or 3 or more simple blocks. Complex: Any of the following criteria are met: 3 or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, field-in-field or other tissue compensation that does not meet IMRT guidelines, or electron beam. Intensity Modulated Radiation Therapy (IMRT), any energy, includes the technical services for guidance Radiation Management and Treatment Table wort IGRT PC (77387- (77387-¢ PC) Code Type Category Code Descriptor pan Bundled (Technical / undle Professional)into into Code? Code? SRS: Stereotactic radiosurgery IMRT: Intensity modulated radiation therapy TC: Technical component SBRT: Stereotactic body radiation therapy IGRT: Image guided radiation therapy PC: Professional component (modifier 26) Treatment 77827 Management N N Professional Treatments Treatment Radiation 77431 Management N N Professional Treatment ~2 Fractions Management SRS 77432 Management, N Y Professional Cranial Lesion(s) 77435 SBRT N Y Professional Management SRS SRS 77371 Multisource Y N Technical Treatment 60 Based Delivery - 77372 SRS Linear Y N Technical Based SBRT SBRT. lor ‘Treatment 77373, More Y N ‘Technical ° Lesions, 1-5 Delivery ” FractionsRadiation Treatment Delivery 77401 77402 77407 77412 Superficial and/or Ortho Voltage Radiation Treatment Delivery, Simple Radiation Treatment Delivery, Intermediate Radiation Treatment Delivery, Complex Technical Technical Technical Technical IMRT Treatment Delivery 77385 77386 IMRT Treatment Delivery, Simple IMRT Treatment Delivery, Complex Technical Technical Neutron Beam Treatment Delivery 77423 Neutron Beam Treatment, Complex Technical 77520 Proton Treatment, simple TechnicalProton Treatment Delivery Proton ‘Treatment, 77322 simple N N ‘Technical Proton 77523 Treatment, N N ‘Technical Intermediate Proton 77525 Treatment, N N Technical Complex Simple: Any of the following: prostate, breast, and all sites using physical compensator based IMRT. Complex: Includes all other sites if not using physical compensator based IMRT. 77401 77402 77407 77412 77417 77385 Radiation treatment delivery, superficial and/or ortho voltage, per day (Do not report 77401 in conjunction with 77373) Radiation treatment delivery, =1 MeV; simple (Do not report 77402 in conjunction with 77373) intermediate (Do not report 77407 in conjunction with 77373) complex (Do not report 77412 in conjunction with 77373) ‘Therapeutic radiology port image(s) (For intensity modulated treatment planning, use 77301) Intensity modulated radiation treatment delivery (IMRT), includes guidance and tracking, when performed; simple (To report professional component [PC] of guidance and77386 77387 77424 77425 tracking, use 77387 with modifier 26) complex (To report professional component [PC] of guidance and tracking, use 77387 with modifier 26) (Do not report 77385, 77386 in conjunction with 77371, 77372, 77373) Guidance for localization of target volume for delivery of radiation treatment, includes intrafraction tracking, when performed (Do not report technical component [TC] with 77385, 77386, 77371, 77372, 77373) (For placement of interstitial device[s] for radiation therapy guidance, see 31627, 32553, 49411, 55876) Intraoperative radiation treatment delivery, x-ray, single treatment session Intraoperative radiation treatment delivery, electrons, single treatment session Neutron Beam Treatment Delivery 77423 77424 77425 (77422 has been deleted) High energy neutron radiation treatment delivery, 1 or more isocenter(s) with coplanar or non-coplanar geometry with blocking and/or wedge, and/or compensator(s) Code is out of numerical sequence. See 77412-77427 Code is out of numerical sequence. See 77412-77427 Radiation Treatment Management Radiation treatment management is reported in units of five fractions or treatment sessions, regardless of the actual time period in which the services are furnished. The services need not be furnished on