1
				74177
				Abdominal and pelvic CT scan with contrast for injury, foreign bodies, or tumors [HCPCS 74177]
				YES
			 
						
			
				2
				76700
				Abdominal ultrasound (complete) [HCPCS 76700]
				YES
			 
						
			
				3
				76805
				Abdominal ultrasound of pregnant uterus after first trimester, greater than or equal to 14 weeks 0 days (single or first fetus) [HCPCS 76805]
				YES
			 
						
			
				4
				64483
				Anesthetic agent and/or steroid injection into lower or sacral spine nerve root with imaging guidance (single level) [HCPCS 64483]
				NO
			 
						
			
				5
				19120
				Breast cyst removal, male or female (1 or more cysts) [HCPCS 19120]
				YES
			 
						
			
				6
				216
				Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with major complications
				NO
			 
						
			
				7
				66984
				Cataract removal involving removal of the front part of the capsule and the central part of the lens with lens prosthesis insertion  [HCPCS 66984]
				NO
			 
						
			
				8
				93452
				Catheter insertion into left heart with injection, imaging interpretation, and supervision [HCPCS 93452]
				NO
			 
						
			
				9
				473
				Cervical spinal fusion without complications
				NO
			 
						
			
				10
				45380
				Colon (large bowel) examination and biopsy with endoscope [HCPCS 45380]
				YES
			 
						
			
				11
				45385
				Colon (large bowel) examination and polyps or tumors removal by snare technique with endoscope [HCPCS 45385]
				YES
			 
						
			
				12
				45391
				Colon (large bowel) examination and ultrasound of large bowel with flexible endoscope [HCPCS 45391]
				NO
			 
						
			
				13
				45378
				Colon (large bowel) examination with endoscope for diagnosis (high risk) [HCPCS 45378]
				YES
			 
						
			
				14
				59510
				Delivery of infant through incision in abdomen and uterus (cesarean delivery) with obstetric care before and after delivery [HCPCS 59510]
				NO
			 
						
			
				15
				59610
				Delivery of infant through uterus and vagina after previous delivery of infant through incision in abdomen and uterus (cesarean delivery) with obstetric care before and after delivery [HCPCS 59610]
				NO
			 
						
			
				16
				59400
				Delivery of infant through uterus and vagina with obstetric care before and after delivery [HCPCS 59400]
				NO
			 
						
			
				17
				43239
				Esophagus, stomach, and/or upper small bowel examination and biopsy with endoscope [HCPCS 43239]
				YES
			 
						
			
				18
				43235
				Esophagus, stomach, and/or upper small bowel examination with endoscope for diagnosis [HCPCS 43235]
				YES
			 
						
			
				19
				90847
				Family psychotherapy treatment with patient (50 minutes) [HCPCS 90847]
				NO
			 
						
			
				20
				90846
				Family psychotherapy treatment without patient (50 minutes) [HCPCS 90846]
				NO
			 
						
			
				21
				47562
				Gallbladder removal with an endoscope [HCPCS 47562]
				YES
			 
						
			
				22
				49505
				Groin hernia repair for patient 5 years of age or older (herniated tissue that is not trapped) [HCPCS 49505]
				YES
			 
						
			
				23
				70450
				Head or brain CT scan without contrast to examine injury, foreign bodies, or tumors [HCPCS 70450]
				YES
			 
						
			
				24
				70553
				Imaging of brain by MRI without contrast, followed by contrast [HCPCS 70553]
				YES
			 
						
			
				25
				73721
				Imaging of leg joint by MRI without contrast [HCPCS 73721]
				YES
			 
						
			
				26
				72148
				Imaging of lower spinal canal by MRI without contrast [HCPCS 72148]
				YES
			 
						
			
				27
				76830
				Imaging of pelvis by ultrasound through vagina [HCPCS 76830]
				YES
			 
						
			
				28
				99385
				Initial new patient well visit (preventive medicine evaluation) to assess overall health and identify potential health problems before they occur (18-39 years of age) [HCPCS 99385]
				YES
			 
						
			
				29
				99386
				Initial new patient well visit (preventive medicine evaluation) to assess overall health and identify potential health problems before they occur (40-64 years of age) [HCPCS 99386]
				YES
			 
						
			
				30
				29881
				Knee cartilage removal with endoscope (one knee) [HCPCS 29881]
				NO
			 
						
			
				31
				80055
				Lab analysis for pregnant woment identify the hepatitis B antigen, rubella anitbody, test for syphilis, and perform ABO and Rh(D) blood typing from blood specimen [HCPCS 80055]
				NO
			 
						
			
				32
				81001
				Lab analysis of urine specimen by dipstick with microscope (automated) [HCPCS 81001]
				YES
			 
						
			
				33
				81000
				Lab analysis of urine specimen by dipstick with microscope (non-automated) [HCPCS 81000]
				YES
			 
						
			
				34
				81003
				Lab analysis of urine specimen by dipstick without microscope (automated) [HCPCS 81003]
				YES
			 
						
			
				35
				81002
				Lab analysis of urine specimen by dipstick without microscope (non-automated) [HCPCS 81002]
				YES
			 
						
			
				36
				80069
				Lab analysis to evaluate kidney function via a blood test panel [HCPCS 80069]
				YES
			 
						
			
				37
				85610
				Lab analysis to evaluate the clotting time in plasma specimen and monitor drug effectiveness [HCPCS 85610]
				YES
			 
						
			
				38
				84443
				Lab analysis to identify the thyroid stimulating hormone (tsh) in blood specimen [HCPCS 84443]
				YES
			 
						
			
				39
				85730
				Lab analysis to measure coagulation in plasma or whole blood specimen [HCPCS 85730]
				YES
			 
						
			
				40
				85027
				Lab analysis to measure complete blood cell count (red cells, white blood cell, and platelets), automated test [HCPCS 85027]
				YES
			 
						
			
				41
				85025
				Lab analysis to measure complete blood cell count (red cells, white blood cell, and platelets), automated test and automated differential white blood cell count [HCPCS 85025]
				YES
			 
						
			
				42
				80076
				Lab analysis to measure the amount of albumin, total and direct bilirubin, alkaline phosphatase, total protein, alanine amino transferase, and asparate amino transferase in blood specimen to evaluate liver function [HCPCS 80076]
				YES
			 
						
			
				43
				84154
				Lab analysis to measure the amount of free PSA (prostate specific antigen) in serum specimen [HCPCS 84154]
				YES
			 
						
			
				44
				80061
				Lab analysis to measure the amount of lipids (cholesterol and triglycerides) in blood specimen [HCPCS 80061]
				YES
			 
						
			
				45
				84153
				Lab analysis to measure the amount of total PSA (prostate specific antigen) in serum specimen [HCPCS 84153]
				YES
			 
						
			
				46
				80048
				Lab analysis to measure the amount of total calcium, carbon dioxide (bicarbonate), chloride, creatinine, glucose,  potassium, sodium, and urea nitrogen (BUN) in blood specimen [HCPCS 80048]
				YES
			 
						
			
				47
				80053
				Lab analysis via blood test to measure a comprehensive group of blood chemicals [HCPCS 80053]
				YES
			 
						
			
				48
				77067
				Mammography of both breasts (screening exam) [HCPCS 77067]
				YES
			 
						
			
				49
				77066
				Mammography of both breasts for diagnosis [HCPCS 77066]
				YES
			 
						
			
				50
				77065
				Mammography of one breast for diagnosis [HCPCS 77065]
				YES
			 
						
			
				51
				99203
				New patient office or outpatient visit with physician to diagnose and treat illness or injury (total time 30-44 minutes) [HCPCS 99203]
				YES
			 
						
			
				52
				99204
				New patient office or outpatient visit with physician to diagnose and treat illness or injury (total time 45-59 minutes) [HCPCS 99204]
				YES
			 
						
			
				53
				99205
				New patient office or outpatient visit with physician to diagnose and treat illness or injury (total time 60-74 minutes) [HCPCS 99205]
				YES
			 
						
			
				54
				99243
				Patient office consultation visit with consulting physician or other qualified health care professional (typically 40 minutes) [HCPCS 99243]
				NO
			 
						
			
				55
				99244
				Patient office consultation visit with consulting physician or other qualified health care professional (typically 60 minutes) [HCPCS 99244]
				NO
			 
						
			
				56
				72193
				Pelvis CT scan with contrast to examine injury, foreign bodies, or tumors [HCPCS 72193]
				YES
			 
						
			
				57
				97110
				Physical therapy exercise to develop strength, endurance, range of motion, and flexibility (each 15 minutes) [HCPCS 97110]
				YES
			 
						
			
				58
				55700
				Prostate gland biopsy [HCPCS 55700]
				NO
			 
						
			
				59
				90832
				Psychotherapy treatment by physician face-to-face with patient (30 minutes) [HCPCS 90832]
				NO
			 
						
			
				60
				90834
				Psychotherapy treatment by physician face-to-face with patient (45 minutes) [HCPCS 90834]
				NO
			 
						
			
				61
				90837
				Psychotherapy treatment by physician face-to-face with patient (60 minutes) [HCPCS 90837]
				NO
			 
						
			
				62
				90853
				Psychotherapy treatment for multiple patients in one group session [HCPCS 90853]
				NO
			 
						
			
				63
				66821
				Recurring cataract removal in lens capsule by laser [HCPCS 66821]
				NO
			 
						
			
				64
				93000
				Routine EKG (electrocardiogram) tracing using at least 12 wires with interpretation and report (complete) [HCPCS 93000]
				YES
			 
						
			
				65
				29826
				Shoulder examination and shoulder bone shaving with endoscope [HCPCS 29826]
				NO
			 
						
			
				66
				95810
				Sleep pattern monitoring of patient in sleep lab, sleep staging with 4 or more parameters of sleep (6 years of age or older) [HCPCS 95810]
				NO
			 
						
			
				67
				62322
				Spinal canal injection of substance into lower back or sacrum [HCPCS 62322]
				NO
			 
						
			
				68
				62323
				Spinal canal injection of substance into lower back or sacrum with imaging guidance [HCPCS 62323]
				NO
			 
						
			
				69
				460
				Spinal fusion other than the neck without major complications
				NO
			 
						
			
				70
				72110
				Spinal x-ray of lower and sacral spine (minimum of 4 views) [HCPCS 72110]
				YES
			 
						
			
				71
				55866
				Surgical prostate removal and surrounding lymph nodes with endoscope [HCPCS 55866]
				NO
			 
						
			
				72
				42820
				Tonsils and adenoid glands removal (younger than 12 years of age) [HCPCS 42820]
				NO
			 
						
			
				73
				470
				Total Knee or Hip Replacement
				NO
			 
						
			
				74
				743
				Uterus or Ovary Surgery Not Related to Cancer without complications
				NO