|
|
|
CPT CODE
|
DESCRIPTION OF COVERED
CODES |
|
99383FP
|
Family Planning Initial/Annual Visit |
|
99384FP
|
|
99386FP
|
|
99385FP
|
|
99393FP
|
|
99394FP
|
|
99395FP
|
|
99396FP
|
|
99403FP
|
Family Planning Counseling Visit |
|
99211FP
|
Family Planning Supply Visit |
|
A4260
|
Norplant System Kit |
|
S4989
|
Progestasert Intrauterine Device |
|
J1055
|
Injection Medroxyprogesterone Acetate |
|
J1056
|
Injection, Medroxyprogesterone Acetate
/ Estradiol Cypionate, 5mg / 25mg |
|
J7300
|
Intrauterine Copper Contraceptive |
|
J7302
|
Levonorgestrel-Releasing Intrauterine
Contraceptive System, 52 Mg |
|
A4261
|
Cervical Cap |
|
00851
|
Anesthesia For Intraperitoneal Procedures
In Lower Abdomen Including Laparoscopy |
|
11975
|
Insertion, Implantable Contraceptive
Capsules |
|
11976
|
Removal of Norplant |
|
11977
|
Removal with Reinsertion, Implantable |
|
56301
|
Laparoscopy, surgical; with fulguration
of oviducts |
|
56302
|
with occlusion of oviducts by device |
|
57170
|
Diaphragm or Cervical Cap fitting
with instructions |
|
57452
|
Colposcopy |
|
57454
|
Colposcopy with Biopsy |
|
57460
|
Colposcopy with Biopsy, loop electrode
excision |
|
58300
|
Insertion of Intrauterine Device |
|
58301
|
Removal of Intrauterine Device |
|
58600
|
Ligation or transection of fallopian
tube (s) |
|
58615
|
Occlusion of fallopian tube (s) by
device |
|
58670
|
Surgical laparoscopy, with fulguration
of oviducts |
|
58671
|
Surgical laparoscopy, with occlusion
of oviducts |
|
00840
|
Anesthesia for intraperitoneal procedure
in lower abdomen |
|
99201
|
Evaluation and Management, new patient |
|
99211
|
Evaluation and Management, established
patient |
| |
|
|
Laboratory Procedures
|
|
81000
|
Urinalysis, by dipstick; non-automated,
with microscopy |
|
81001
|
automated, with microscopy |
|
81002
|
non-automated, without microscopy |
|
81003
|
automated, without microscopy |
|
81005
|
Urinalysis; Qualitative or semiqualitative |
|
81007
|
Urinalysis; bacteriuria screen, by
kit |
|
81015
|
Urinalysis; bacteriuria screen, microscopic
only |
|
81025
|
Urine pregnancy test, by visual color
comparison |
|
82947
|
Glucose; quantitative |
|
84702
|
Gonadotropin, chorionic (hCG); quantitative |
|
84703
|
Gonadotropin, chorionic (hCG); qualitative |
|
85007
|
Blood count; manual differential
WBC count |
|
85018
|
Hemoglobin |
|
85014
|
Hematocrit, other than spun |
|
86255
|
Fluorescent antibody; screen, each
antibody (HIV & Herpes) |
|
86382
|
Neutralization test, viral |
|
86403
|
Rubella screen (IgG) |
|
86580
|
Tuberculosis, intradermal |
|
86585
|
Tuberculosis, tine test |
|
86592
|
Syphilis test; qualitative (e.g.,
VDRL, RPR,ART) |
|
86593
|
Syphilis test; quantitative |
|
86689
|
HTLV or HIV antibody, confirmatory
test (western blot) |
|
86694
|
Herpes simplex, non-specific type
test |
|
86695
|
Herpes simplex, type I |
|
86701
|
HIV-1 |
|
86703
|
HIV-1 and HIV-2, single assay |
|
86706
|
Hepatitis B surface antibody (HBsAb) |
|
86707
|
Hepatitis Be antibody (HBeAb) |
|
86762
|
Rubella titer |
|
86781
|
Antibody; Treponema Pallidum (Syphilis
Confirmatory) |
|
86803
|
Hepatitis C antibody |
|
87060
|
Throat culture |
|
87070
|
Culture, bacterial, definitive; any
other source (GC) |
|
87075
|
Culture, bacterial, any source; anaerobic
(isolation) |
|
87081
|
Culture, bacterial, screening only
(GC) |
|
87082
|
Culture, presumptive, pathogenic
organisms, by kit (GC) |
|
87086
|
Culture, bacterial, urine; quantitative,
colony count |
|
87087
|
commercial kit |
|
87110
|
Culture, chlamydia |
|
87164
|
Dark field examination |
|
87205
|
Neisseria gonorrhoeae smear |
|
87206
|
Smear, primary source, with interpretation;
(chlamydia) |
|
87210
|
Smear, primary source, wet mount
isolation, with stain |
|
87252
|
Virus identification; tissue culture
inoculation & observation |
|
87340
|
Hepatitis B surface antigen (HBsAg) |
|
87350
|
Hepatitis Be antigen (HBeAg) |
|
87480
|
Candida species, direct probe technique |
|
87481
|
Candida species, amplified probe
technique |
|
87490
|
Chlamydia trachomatis, direct probe
technique |
|
87491
|
Chlamydia trachomatis, amplified
probe technique |
|
87510
|
Gardnerella vaginalis, direct probe
technique |
|
87511
|
Gardnerella vaginalis, amplified
probe technique |
|
87515
|
Hepatitis B virus, direct probe technique |
|
87516
|
Hepatitis B virus, amplified probe
technique |
|
87520
|
Hepatitis C virus, direct probe technique |
|
87521
|
Hepatitis C virus, amplified probe
technique |
|
87528
|
Herpes simplex virus, direct probe
technique |
|
87529
|
Herpes simplex virus, amplified probe
technique |
|
87590
|
Neisseria gonorrhoeae, direct probe
technique |
|
87591
|
Neisseria gonorrhoeae, amplified
probe technique |
|
87620
|
Papillomavirus, human, direct probe
technique |
|
87621
|
Papillomavirus, human, amplified
probe technique |
|
88141
|
Cytopathology, cervical or vaginal
(any system phy interpret) |
|
88142
|
Cytopathology, cervical or vaginal
(preservative fluid) |
|
88143
|
Cytopathology, cervical
or vaginal (manual screen & re-screen |
|
88144
|
Cytopathology, cervical or vaginal
(man. screen & computer re-screen |
|
|
|
88145
|
Cytopathology, cervical or vaginal
(cell selection) |
|
88150
|
Cytopathology, smears, cervical or
vaginal |
|
88152
|
with manual cytotech screening under
physician supervision |
|
88153
|
Cytopathology, slides (man. screen
& re-screen) |
|
88154
|
Cytopathology, slides (man. screen
& computer re-screen |
|
88155
|
Cytopathology, smears, with definitive
hormonal eval |
|
88156
|
Cytopathology, smears (the Bethesda
System (TBS)) |
|
88158
|
with manual cytotech screening under
physician supervision |
|
88164
|
Cytopathology (Bethesda, manual screening) |
|
88165
|
Cytopathology (Bethesda, manual screen
& re-screen) |
|
88166
|
Cytopathology (Bethesda, manual screen
& computer re-screen |
|
88167
|
Cytopathology (Bethesda, cell selection) |
|
|
| |
|
|
HIV
Counseling Codes
|
|
99401
|
Preventive medicine counseling, 15
minutes |
|
99402
|
Preventive medicine counseling, 30
minutes |
|
|
| |
|
|
|
|
66.21
|
Bilateral endoscopic ligation and
crushing of fallopian tubes |
|
66.22
|
Bilateral endoscopic ligation and
division of fallopian tubes |
|
66.29
|
Other bilateral endoscopic ligation
and division of fallopian |
|
66.31
|
Other bilateral ligation and crushing
of fallopian tubes |
|
66.32
|
Other bilateral ligation and division
of fallopian tubes |
|
66.39
|
Other bilateral destruction or occlusion
of fallopian tubes |
| |
|
|
|
|
V25.0
|
|
|
V25.01
|
|
|
V25.02
|
|
|
V25.09
|
|
|
V25.1
|
|
|
V25.2
|
|
|
V25.3
|
|
|
V25.4
|
|
|
V25.40
|
|
|
V25.41
|
|
|
V25.42
|
|
|
V25.43
|
|
|
V25.49
|
|
|
V25.5
|
|
|
V25.8
|
|
|
V25.9
|
|
| |
|
|
|
|
622.1
|
|
|
795.0
|
|
|
795.1
|
|
| |
|
|
|
|
634.0-634.9
|
|
|
078.0-078.19
|
|
|
054.0-054.9
|
|
|
079.88,079.98
|
|
|
090.3-099.9
|
|
|
112.0-112.9
|
|
|
131.0-131.9
|
|
| |
|
|
Pharmacy
- Generic
|
|
Benzathine PCN G
|
Ofloxacin
|
|
Aqueous procaine PCN G
|
Cefotaxime
|
|
Erythromycin
|
Ceftizoxime
|
|
Tetracycline
|
Amoxicillin
|
|
Ceftriaxone
|
Metronidazole
|
|
Doxycycline
|
Metrojel
|
|
Spectinomycin
|
Azithromycin
|
|
Ciprofloxacin
|
Miconazole
|
|
Norfloxacin
|
Terconazole
|
|
Cefuroxime
|
Diflucan
|
|
Probenecid
|
Acyclovir
|
|
Cefixime
|
