Workers' compensation -- HIPAA 835 Health care claim payment/remittance advice
5221.4033 Outpatient limitation for medical/surgical facility fee
Subp. 2b. Procedure codes subject to limitation (table continued ...)
procedure code
description25530 Treat fracture of ulna 25600 Treat fracture radius/ulna 25622 Treat wrist bone fracture 25630 Treat wrist bone fracture 25650 Repair wrist bone fracture 26010 Drainage of finger abscess 26600 Treat metacarpal fracture 26720 Treat finger fracture, each 26725 Treat finger fracture, each 26740 Treat finger fracture, each 28001 Drainage of bursa of foot 28010 Incision of toe tendon 28011 Incision of toe tendons 28022 Exploration of foot joint 28024 Exploration of toe joint 28052 Biopsy of foot joint lining 28108 Removal of toe lesions 28124 Partial removal of toe 28126 Partial removal of toe 28153 Partial removal of toe 28160 Partial removal of toe 28190 Removal of foot foreign body 28220 Release of foot tendon 28230 Incision of foot tendon(s) 28232 Incision of toe tendon 28234 Incision of foot tendon 28270 Release of foot contracture 28272 Release of toe joint, each 28430 Treatment of ankle fracture 28450 Treat midfoot fracture, each 28455 Treat midfoot fracture, each 28470 Treat metatarsal fracture 28475 Treat metatarsal fracture 28490 Treat big toe fracture 28495 Treat big toe fracture 28510 Treatment of toe fracture 28515 Treatment of toe fracture 28530 Treat sesamoid bone fracture 28540 Treat foot dislocation 28570 Treat foot dislocation 28600 Treat foot dislocation 28630 Treat toe dislocation 29015 Application of body cast 29020 Application of body cast 29025 Application of body cast 29035 Application of body cast 29049 Application of shoulder cast 29065 Application of long arm cast 29075 Application of forearm cast 29085 Apply hand/wrist cast 29105 Apply long arm splint 29125 Apply forearm splint 29126 Apply forearm splint 29130 Application of finger splint 29131 Application of finger splint 29200 Strapping of chest 29220 Strapping of low back 29260 Strapping of elbow or wrist 29280 Strapping of hand or finger 29345 Application of long leg cast 29355 Application of long leg cast 29358 Apply long leg cast brace 29365 Application of long leg cast 29405 Apply short leg cast 29425 Apply short leg cast 29435 Apply short leg cast 29440 Addition of walker to cast 29450 Application of leg cast 29515 Application of lower leg splint 29520 Strapping of hip 29530 Strapping of knee 29540 Strapping of ankle 29550 Strapping of toes 29580 Application of paste boot 29590 Application of foot splint 29700 Removal/revision of cast 29705 Removal/revision of cast 29710 Removal/revision of cast 29715 Removal/revision of cast 29720 Repair of body cast 29730 Windowing of cast 29740 Wedging of cast 29750 Wedging of clubfoot cast 29850 Knee arthroscopy/surgery 30000 Drainage of nose lesion 30020 Drainage of nose lesion 30100 Intranasal biopsy 30110 Removal of nose polyp(s) 30200 Injection treatment of nose 30210 Nasal sinus therapy 30220 Insert nasal septal button 30300 Remove nasal foreign body 30901 Control of nosebleed 31000 Irrigation maxillary sinus 31002 Irrigation sphenoid sinus 31505 Diagnostic laryngoscopy 31575 Diagnostic laryngoscopy 31579 Diagnostic laryngoscopy 36000 Place needle in vein 36400 Drawing blood 36405 Drawing blood 36406 Drawing blood 36410 Drawing blood 36430 Blood transfusion service 36450 Exchange transfusion service 36470 Injection therapy of vein 36471 Injection therapy of vein 36510 Insertion of catheter, vein 40490 Biopsy of lip 40800 Drainage of mouth lesion 40804 Removal of foreign body, mouth 40808 Biopsy of mouth lesion 40810 Excision of mouth lesion 40812 Excise/repair mouth lesion 41100 Biopsy of tongue 41108 Biopsy of floor of mouth 41825 Excision of gum lesion 41826 Excision of gum lesion 42100 Biopsy roof of mouth 42330 Removal of salivary stone 42400 Biopsy of salivary stone 42650 Dilation of salivary duct 42660 Dilation of salivary duct 42800 Biopay of throat 45300 Proctosigmoidoscopy 45303 Proctosigmoidoscopy 45330 Sigmoidoscopy, diagnostic 45520 Treatment of rectal prolapse 46083 Incise external hemorrhoid 46221 Ligation of hemorrhoid(s) 46230 Removal of anal tabs 46320 Removal of hemorrhoid clot 46500 Injection into hemorrhoids 46600 Diagnostic anoscopy 46604 Anoscopy and dilation 46606 Anoscopy and biopsy 46614 Anoscopy, control bleeding 46615 Anoscopy 46900 Destruction, anal lesion(s) 46910 Destruction, anal lesion(s) 46916 Cryosurgery, anal lesion(s) 46917 Laser surgery, anal lesion(s) 46934 Destruction of hemorrhoids 46935 Destruction of hemorrhoids 46936 Destruction of hemorrhoids 46940 Treatment of anal fissure 46942 Treatment of anal fissure 46945 Ligation of hemorrhoids 46946 Ligation of hemorrhoids 51700 Irrigation of bladder 51705 Change of bladder tube 51720 Treatment of bladder lesion 52265 Cystoscopy and treatment 53270 Removal of urethra gland 53600 Dilate urethra stricture 53601 Dilate urethra stricture Back to rule page | Page two | Page three (next) | Page four
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