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5221.4033 Outpatient limitation for medical/surgical facility fee

Subp. 2b. Procedure codes subject to limitation (table continued ...)

CPT/HCPCS
procedure code
CPT/HCPCS
description
53620 Dilate urethra stricture
53621 Dilate urethra stricture
53660 Dilation of urethra
53661 Dilation of urethra
53670 Insert urinary catheter
54050 Destruction, penis lesion(s)
54055 Destruction, penis lesion(s)
54056 Cryosurgery, penis lesion(s)
54200 Treatment of penis lesion
54230 Prepare penis study
54235 Penile injection
55000 Drainage of hydrocele
55250 Removal of sperm duct(s)
56420 Drainage of gland abscess
56501 Destruction, vulva lesion(s)
56606 Biopsy of vulva/perineum
57061 Destruction, vagina lesion(s)
57100 Biopsy of vagina
57150 Treat vagina infection
57160 Insertion of pessary
57170 Fitting of diaphragm/cap
57452 Examination of vagina
57454 Vagina examination and biopsy
57460 LEEP procedure
57500 Biopsy of cervix
57505 Endocervical curettage
57510 Cauterization of cervix
57511 Cryocautery of cervix
58100 Biopsy of uterus lining
58301 Remove intrauterine device
59200 Insert cervical dilator
59300 Episiotomy or vagional repair
59425 Antepartum care only
59426 Antepartum care only
59430 Care after delivery
60100 Biopsy of thyroid
61001 Remove cranial cavity fluid
63690 Analysis of neuroreceiver
63691 Analysis of neuroreceiver
64400 Injection for nerve block
64405 Injection for nerve block
64408 Injection for nerve block
64412 Injection for nerve block
64413 Injection for nerve block
64418 Injection for nerve block
64435 Injection for nerve block
64440 Injection for nerve block
64441 Injection for nerve block
64445 Injection for nerve block
64450 Injection for nerve block
64505 Injection for nerve block
64508 Injection for nerve block
64550 Apply neurostimulator
64553 Implant neuroelectrodes
64555 Implant neuroelectrodes
64560 Implant neuroelectrodes
64565 Implant neuroelectrodes
64612 Destroy nerve, face muscle
64613 Destroy nerve, spine muscle
65205 Remove foreign body from eye
65210 Remove foreign body from eye
65220 Remove foreign body from eye
65222 Remove foreign body from eye
65286 Repair of eye wound
65430 Corneal smear
65435 Curette/treat cornea
654336 Curette/treat cornea
65600 Revision of cornea
65772 Correction of astigmatism
65855 Laser surgery of eye
65860 Incise inner eye adhesions
66761 Revision of iris
66770 Removal of inner eye lesion
67145 Treatment of retina
67210 Treatment of retinal lesion
67228 Treatment of retinal lesion
67345 Destroy nerve of eye muscle
67505 Inject/treat eye socket
67515 Inject/treat eye socket
67700 Drainage of eyelid abscess
67710 Incision of eyelid
67800 Remove eyelid lesion
67801 Remove eyelid lesions
67805 Remove eyelid lesions
67810 Biopsy of eyelid
67820 Revise eyelashes
67825 Revise eyelashes
67840 Remove eyelid lesion
67850 Treat eyelid lesion
67915 Repair eyelid defect
67922 Repair eyelid defect
67930 Repair eyelid wound
67938 Remove eyelid foreign body
68020 Incise/drain eyelid lining
68040 Treatment of eyelid lesions
68100 Biopsy of eyelid lining
68110 Remove eyelid lining lesion
68135 Remove eyelid lining lesion
68200 Treat eyelid by injection
68400 Incise/drain tear gland
68420 Incise/drain tear sac
68440 Incise tear duct opening
68530 Clearance of tear duct
68705 Revise tear duct opening
68760 Close tear duct opening
68761 Close tear duct opening
68770 Close tear system fistula
68840 Explore/irrigate tear ducts
69000 Drain external ear lesion
69005 Drain external ear lesion
69020 Drain outer ear canal lesion
69100 Biopsy of external ear
69105 Biopsy of external ear canal
69200 Clear outer ear canal
69210 Remove impacted ear wax
69220 Clean out mastoid cavity
69222 Clean out mastoid cavity
69400 Inflate middle ear canal
69401 Inflate middle ear canal
69405 Catheterize middle ear canal
69410 Insert middle ear baffle
69420 Incision of eardrum
69433 Create eardrum opening
69540 Remove ear lesion
69610 Repair of eardrum
92002 Eye exam, new patient
92004 Eye exam, new patient
92012 Eye exam, established patient
92014 Eye exam and treatment
92019 Eye exam and treatment
92020 Special eye evaluation
92070 Fitting of contact lens
92100 Serial tonometry exam(s)
92120 Tonography and eye evaluation
92130 Water provocation tonography
92140 Glaucoma provocative tests
92225 Special eye exam, initial
92226 Special eye exam, subsequent
92230 Eye exam with photos
92260 Ophthalmoscopy/dynamometry
92287 Internal eye photography
92311 Contact lens fitting
92312 Contact lens fitting
92313 Contact lens fitting
92315 Prescription of contact lens
92316 Prescription of contact lens
92317 Prescription of contact lens
92330 Fitting of artificial eye
92335 Fitting of artificial eye
92352 Special spectacles fitting
92353 Special spectacles fitting
92354 Special spectacles fitting
92371 Repair and adjust spectacles
92504 Ear microscopy examination
92506 Speech and hearing evaluation
92507 Speech/hearing therapy
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