Untimed Billing Procedure CPT Codes Effective February 1, 2010

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Procedure Main Description Specific Description

20552 Therapeutic injections: Tendons, trigger points single or multiple trigger points; 1 or 2 muscles 20553 Therapeutic injections: Tendons, trigger points single or multiple trigger points; 3 or more muscles 90801 Psychiatric diagnostic interview examination

90804 Individual outpatient psychotherapy

individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 20-30 minutes face to face with patient

90806

Individual outpatient psychotherapy

individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 45-50 minutes face to face with patient

90808 Individual outpatient psychotherapy

individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 75-80 minutes face to face with patient

90810 Individual outpatient interactive psychotherapy

individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an office or outpatient facility, approximately 20 to 30 minutes face-to-face with the patient

90812 Individual outpatient interactive psychotherapy

individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an office or outpatient facility, approximately 45 to 50 minutes face-to-face with the patient

90814 Individual outpatient interactive psychotherapy

individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an office or outpatient facility, approximately 75 to 80 minutes face-to-face with the patient

90816

Individual inpatient psychotherapy

individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an inpatient hospital, partial hospital or residential care setting, approximately 20 to 30 minutes face-to-face with the patient

90818 Individual inpatient psychotherapy

individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an inpatient hospital, partial hospital or residential care setting, approximately 45 to 50 minutes face-to-face with the patient

90821 Individual inpatient psychotherapy

individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an inpatient hospital, partial hospital or residential care setting, approximately 75 to 80 minutes face-to-face with the patient

90823

Inpatient individual psychotherapy: Interactive

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Procedure Main Description Specific Description

90826

Inpatient individual psychotherapy: Interactive

individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an inpatient hospital, partial hospital or residential care setting, approximately 45 to 50 minutes face-to-face with the patient

90828

Inpatient individual psychotherapy: Interactive

individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an inpatient hospital, partial hospital or residential care setting, approximately 75 to 80 minutes face-to-face with the patient

92526 Special procedures of the ears/nose/throat treatment of swallowing dysfunction and/or oral function of feeding 92609 Services related to hearing and speech devices therapeutic services for the use of speech-generating device, including programming and modification

92610 Swallowing evaluations evaluation of oral and pharyngeal swallowing function

92612 Swallowing evaluations

flexible fiberoptic endoscopic evaluation of swallowing by cine or video recording

95117 Allergy immunotherapy 2 or more injections

97001

Physical medicine

assessments physical therapy evaluation

97003 Physical medicine assessments occupational therapy evaluation

99201 Outpatient and other visits

office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Physicians typically spend 10 minutes face-to-face with the patient and/or family.

99202 Outpatient and other visits

office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination;

Straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to

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Procedure Main Description Specific Description

99203 Outpatient and other visits

office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed

examination; Medical decision making of low complexity. Counseling and/or coordination of care with other

providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of

moderate severity. Physicians typically spend 30 minutes face-to-face with the patient and/or family.

99204 Outpatient and other visits

office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A

comprehensive examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 45 minutes face-to-face with the patient and/or family.

99205 Outpatient and other visits

office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A

comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting

problem(s) are of moderate to high severity. Physicians typically spend 60 minutes face-to-face with the patient and/or family.

99211 Outpatient and other visits

office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician. Usually, the

presenting problem(s) are minimal. Typically, 5 minutes are spent performing or supervising these services.

99212 Outpatient and other visits

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Procedure Main Description Specific Description

99213 Outpatient and other visits

office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded

problem focused history; an expanded problem focused examination; Medical decision making of low complexity. Counseling and coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to

moderate severity. Physicians typically spend 15 minutes face-to-face with the patient and/or family.

99214 Outpatient and other visits

office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed history; a detailed examination; Medical decision making of

moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 25 minutes face-to-face with the patient and/or family.

99215 Outpatient and other visits

office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A comprehensive history; a comprehensive examination; Medical decision making of high complexity. Counseling and/or

coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the

presenting problem(s) are of moderate to high severity. Physicians typically spend 40 minutes face-to-face with the patient and/or family.

99238

Inpatient hospital

discharge services hospital discharge day management: 30 minutes or less

99239 Inpatient hospital discharge services more than 30 minutes

99241 Consultations

office consultation for a new or established patient, which requires these 3 key components: A problem focused history; A problem focused examination; and

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Procedure Main Description Specific Description

99242 Consultations

office consultation for a new or established patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused

examination; and Straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low severity. Physicians typically spend 30 minutes face-to-face with the patient and/or family.

99243 Consultations

office consultation for a new or established patient, which requires these 3 key components: A detailed history; A detailed examination; and Medical decision making of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Physicians typically spend 40 minutes face-to-face with the patient and/or family.

99244 Consultations

office consultation for a new or established patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 60 minutes face-to-face with the patient and/or family.

99245 Consultations

office consultation for a new or established patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the

presenting problem(s) are of moderate to high severity. Physicians typically spend 80 minutes face-to-face with the patient and/or family.

99251 Consultations

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Procedure Main Description Specific Description

99252 Consultations

inpatient consultation for a new or established patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low severity. Physicians typically spend 40 minutes at the bedside and on the patient's hospital floor or unit.

99253 Consultations

inpatient consultation for a new or established patient, which requires these 3 key components: A detailed history; A detailed examination; and Medical decision making of low complexity. Counseling and/or

coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the

presenting problem(s) are of moderate severity.

Physicians typically spend 55 minutes at the bedside and on the patient's hospital floor or unit.

99254 Consultations

inpatient consultation for a new or established patient, which requires these 3 key components: A

comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of

moderate to high severity. Physicians typically spend 80 minutes at the bedside and on the patient's hospital floor or unit.

99255 Consultations

inpatient consultation for a new or established patient, which requires these 3 key components: A

comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of

(7)

Procedure Main Description Specific Description

99304 Nursing facility visits

initial nursing facility care, per day, for the evaluation and management of a patient, which requires these 3 key components: A detailed or comprehensive history; A detailed or comprehensive examination; and Medical decision making that is straightforward or of low

complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring

admission are of low severity. Physicians typically spend 25 minutes with the patient and/or family or caregiver.

99305 Nursing facility visits

initial nursing facility care, per day, for the evaluation and management of a patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring

admission are of moderate severity. Physicians typically spend 35 minutes with the patient and/or family or caregiver.

99306 Nursing facility visits

initial nursing facility care, per day, for the evaluation and management of a patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of high

complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring

admission are of high severity. Physicians typically spend 45 minutes with the patient and/or family or caregiver.

99307 Nursing facility visits

subsequent nursing facility care, per day, for the

evaluation and management of a patient, which requires at least 2 of these 3 key components: A problem focused interval history; A problem focused examination;

(8)

Procedure Main Description Specific Description

99308 Nursing facility visits

subsequent nursing facility care, per day, for the

evaluation and management of a patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is responding inadequately to therapy or has developed a minor

complication. Physicians typically spend 15 minutes with the patient and/or family or caregiver.

99309 Nursing facility visits

subsequent nursing facility care, per day, for the

evaluation and management of a patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient has developed a significant complication or a significant new problem. Physicians typically spend 25 minutes with the patient and/or family or caregiver.

99310 Nursing facility visits

subsequent nursing facility care, per day, for the

evaluation and management of a patient, which requires at least 2 of these 3 key components. A comprehensive interval history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. The patient may be unstable or may have developed a significant new problem requiring immediate physician attention. Physicians typically spend 35 minutes with the patient and/or family or caregiver.

99324 Domiciliary care, rest home, assisted living visits

domiciliary or rest home visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting

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Procedure Main Description Specific Description

99325 Domiciliary care, rest home, assisted living visits

domiciliary or rest home visit for the evaluation and management of a new patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Medical decision making of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the

presenting problem(s) are of moderate severity. Physicians typically spend 30 minutes with the patient and/or family or caregiver.

99326 Domiciliary care, rest home, assisted living visits

domiciliary or rest home visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed

examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 45 minutes with the patient and/or family or caregiver.

99327 Domiciliary care, rest home, assisted living visits

domiciliary or rest home visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A

comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of high severity. Physicians typically spend 60 minutes with the patient and/or family or caregiver.

99328 Domiciliary care, rest home, assisted living visits

and Medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is unstable or has developed a significant new problem requiring immediate physican attention. Physicians typically spend 75 minutes with the patient and/or family or caregiver.

99334 Domiciliary care, rest home, assisted living visits

(10)

Procedure Main Description Specific Description

99335 Domiciliary care, rest home, assisted living visits

domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded

problem focused internal history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Physicians typically spend 25 minutes with the patient and/or family or caregiver.

99336 Domiciliary care, rest home, assisted living visits

domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 40 minutes with the patient and/or family or caregiver.

99337 Domiciliary care, rest home, assisted living visits

domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A comprehensive interval history; A comprehensive examination; Medical decision making of moderate to high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of

moderate to high severity. The patient may be unstable or may have developed a significant new problem

requiring immediate physical attention. Physicians typically spend 60 minutes with the patient and/or family or caregiver.

99341 Home visits

home visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other providers or

(11)

Procedure Main Description Specific Description

99342 Home visits

home visit for the evaluation and management of a new patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Medical decision making of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent wit the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Physicians typically spend 30 minutes face-to-face with the patient and/or family.

99343 Home visits

home visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent wit the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 45 minutes face-to-face with the patient and/or family.

99344 Home visits

home visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent wit the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of high severity. Physicians typically spend 60 minutes face-to-face with the patient and/or family.

99345 Home visits

and Medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent wit the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is unstable or has developed a significant new problem requiring immediate physician attention. Physicians typically spend 75 minutes face-to-face with the patient and/or family.

99347 Home visits

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Procedure Main Description Specific Description

99348 Home visits

home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to

moderate severity. Physicians typically spend 25 minutes face-to-face with the patient and/or family.

99349 Home visits

home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are moderate to high severity. Physicians typically spend 40 minutes face-to-face with the patient and/or family.

99350 Home visits

home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A comprehensive interval history; A comprehensive examination; Medical decision making of moderate to high complexity. Counseling and/or

coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the

presenting problem(s) are of moderate to high severity. The patient may be unstable or may have developed a significant new problem requiring immediate physician attention. Physicians typically spend 60 minutes face-to-face with the patient and/or family.

99354

Prolonged services outside customary services

prolonged physician service in the office or other

outpatient setting requiring direct (face-to-face) patient contact beyond the usual service. First hour list

separately in addition to code the office or other outpatient Evaluation and Management service.

99395 Preventive medicine visits 18-39 years

99401

Counseling services: Risk factor and behavioral change modification

preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure), approximately 15 minutes 99402

Counseling services: Risk factor and behavioral

change modification approximately 30 minutes

(13)

Procedure Main Description Specific Description

99411

Counseling services: Risk factor and behavioral change modification

preventive medicine counseling and/or risk factor reduction intervention(s) provided to individuals in a group setting (separate procedure), approximately 30 minutes

99412

Counseling services: Risk factor and behavioral

change modification approximately 60 minutes

99466 Critical care transport age 24 months or younger

Figure

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References

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