CPT 2015 Professional Edition: Current Procedural Terminology

993 Pages·2014·35.289 MB·English

by  American Medical Association

2015
Professional Edition
current procedural
terminology
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The only official CPT® codebook with rules and guidelines from the AMA’s CPT Editorial Panel
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Place-of-Service Codes for Professional Claims
Listed below are place-of-service codes and descriptions. These codes should be used on professional claims to specify the entity where
service(s) were rendered. Check with individual payers (eg, Medicare, Medicaid, other private insurance) for reimbursement policies
regarding these codes. If you would like to comment on a code(s) or description(s), please send your request to [email protected].
Place of
Service Place of Service
Code(s) Name Place of Service Description
A facility or location where drugs and other medically related items and services are sold, dispensed, or
01 Pharmacy
otherwise provided directly to patients. (Effective 10/1/05)
02 Unassigned N/A
03 School A facility whose primary purpose is education.
A facility or location whose primary purpose is to provide temporary housing to homeless individuals (eg,
04 Homeless Shelter
emergency shelters, individual or family shelters).
A facility or location, owned and operated by the Indian Health Service, which provides diagnostic,
Indian Health Service
05 therapeutic (surgical and non‑surgical), and rehabilitation services to American Indians and Alaska
Free‑Standing Facility
Natives who do not require hospitalization.
A facility or location, owned and operated by the Indian Health Service, which provides diagnostic,
Indian Health Service
06 therapeutic (surgical and non‑surgical), and rehabilitation services rendered by, or under the supervision
Provider‑Based Facility
of, physicians to American Indians and Alaska Natives admitted as inpatients or outpatients.
A facility or location owned and operated by a federally recognized American Indian or Alaska Native
Tribal 638
07 tribe or tribal organization under a 638 agreement which provides diagnostic, therapeutic (surgical and
Free‑Standing Facility
non‑surgical), and rehabilitation services to tribal members who do not require hospitalization.
A facility or location owned and operated by a federally recognized American Indian or Alaska Native
Tribal 638
08 tribe or tribal organization under a 638 agreement which provides diagnostic, therapeutic (surgical and
Provider‑Based Facility
non‑surgical), and rehabilitation services to tribal members admitted as inpatients or outpatients.
A prison, jail, reformatory, work farm, detention center, or any other similar facility maintained by either
09 Prison/Correctional Facility Federal, State, or local authorities for the purpose of confinement or rehabilitation of adult or juvenile
criminal offenders. (Effective 7/1/06)
10 Unassigned N/A
Location, other than a hospital, skilled nursing facility (SNF), military treatment facility, community health
11 Office center, State or local public health clinic, or intermediate care facility (ICF), where the health professional
routinely provides health examinations, diagnosis, and treatment of illness or injury on an ambulatory basis.
12 Home Location, other than a hospital or other facility, where the patient receives care in a private residence.
Congregate residential facility with self‑contained living units providing assessment of each resident’s
13 Assisted Living Facility needs and on‑site support 24 hours a day, 7 days a week, with the capacity to deliver or arrange for
services including some health care and other services. (Effective 10/1/03)
A residence, with shared living areas, where clients receive supervision and other services such as social
14 Group Home and/or behavioral services, custodial service, and minimal services (eg, medication administration).
(Effective 10/1/03)
A facility/unit that moves from place‑to‑place equipped to provide preventive, screening, diagnostic,
15 Mobile Unit
and/or treatment services.
A short term accommodation such as a hotel, camp ground, hostel, cruise ship or resort where the patient
16 Temporary Lodging
receives care, and which is not identified by any other POS code. (Effective 4/1/08)
A walk‑in health clinic, other than an office, urgent care facility, pharmacy, or independent clinic, which is
17 Walk‑in Retail Health Clinic not described by any other Place of Service code, that is located within a retail operation and provides, on
an ambulatory basis, preventive and primary care services. (Effective 5/1/10)
A location, not described by any other POS code, owned or operated by a public or private entity where
Place of Employment— the patient is employed, and where a health professional provides on‑going or episodic occupational
18
Worksite medical, therapeutic or rehabilitative services to the individual. (This code is available for use effective
January 1, 2013 but no later than May 1, 2013.)
19 Unassigned N/A
Location, distinct from a hospital emergency room, an office, or a clinic, whose purpose is to diagnose
20 Urgent Care Facility and treat illness or injury for unscheduled, ambulatory patients seeking immediate medical attention.
(Effective 1/1/03)
A facility, other than psychiatric, which primarily provides diagnostic, therapeutic (both surgical and
21 Inpatient Hospital non‑surgical), and rehabilitation services by, or under, the supervision of physicians to patients admitted
for a variety of medical conditions.
A portion of a hospital which provides diagnostic, therapeutic (both surgical and non‑surgical), and
22 Outpatient Hospital
rehabilitation services to sick or injured persons who do not require hospitalization or institutionalization.
23 Emergency Room—Hospital A portion of a hospital where emergency diagnosis and treatment of illness or injury is provided.
Ambulatory Surgical A free‑standing facility, other than a physician’s office, where surgical and diagnostic services are
24
Center provided on an ambulatory basis.
A facility, other than a hospital’s maternity facilities or a physician’s office, which provides a setting for
25 Birthing Center
labor, delivery, and immediate postpartum care as well as immediate care of newborn infants.
A medical facility operated by one or more of the Uniformed Services. Military treatment facility (MTF) also
26 Military Treatment Facility refers to certain former U.S. Public Health Service (USPHS) facilities now designated as Uniformed Service
Treatment Facilities (USTF).
27‑30 Unassigned N/A
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i
A facility that primarily provides inpatient skilled nursing care and related services to patients who
31 Skilled Nursing Facility require medical, nursing, or rehabilitative services but does not provide the level of care or treatment
available in a hospital.
A facility that primarily provides to residents skilled nursing care and related services for the
32 Nursing Facility rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health‑related care services
above the level of custodial care to other than mentally retarded individuals.
A facility that provides room, board, and other personal assistance services, generally on a
33 Custodial Care Facility
long‑term basis, and which does not include a medical component.
A facility, other than a patient’s home, in which palliative and supportive care for terminally ill patients
34 Hospice
and their families are provided.
35‑40 Unassigned N/A
A land vehicle specifically designed, equipped and staffed for lifesaving and transporting the sick or
41 Ambulance—Land
injured.
An air or water vehicle specifically designed, equipped, and staffed for lifesaving and transporting the
42 Ambulance—Air or Water
sick or injured.
43‑48 Unassigned N/A
A location, not part of a hospital and not described by any other Place of Service code, that is organized
49 Independent Clinic and operated to provide preventive, diagnostic, therapeutic, rehabilitative, or palliative services to
outpatients only. (Effective 10/1/03)
Federally Qualified A facility located in a medically underserved area that provides Medicare beneficiaries preventive primary
50
Health Center medical care under the general direction of a physician.
A facility that provides inpatient psychiatric services for the diagnosis and treatment of mental illness on
51 Inpatient Psychiatric Facility
a 24‑hour basis, by or under the supervision of a physician.
A facility for the diagnosis and treatment of mental illness that provides a planned therapeutic program
Psychiatric Facility—
52 for patients who do not require full time hospitalization, but who need broader programs than are
Partial Hospitalization
possible from outpatient visits to a hospital‑based or hospital‑affiliated facility.
A facility that provides the following services: outpatient services, including specialized outpatient services
for children, the elderly, individuals who are chronically ill, and residents of the CMHC’s mental health
Community Mental services area who have been discharged from inpatient treatment at a mental health facility; 24 hour a day
53
Health Center emergency care services; day treatment, other partial hospitalization services, or psychosocial rehabilitation
services; screening for patients being considered for admission to State mental healthfacilitiestodetermine
the appropriateness of such admission; and consultation and education services.
A facility that primarily provides health‑related care and services above the level of custodial care to
Intermediate Care
54 mentally retarded individuals but does not provide the level of care or treatment available in a hospital or
Facility/Mentally Retarded
SNF.
A facility which provides treatment for substance (alcohol and drug) abuse to live‑in residents who do
Residential Substance
55 not require acute medical care. Services include individual and group therapy and counseling, family
Abuse Treatment Facility
counseling, laboratory tests, drugs and supplies, psychological testing, and room and board.
Psychiatric Residential A facility or distinct part of a facility for psychiatric care which provides a total 24‑hour therapeutically
56
Treatment Center planned and professionally staffed group living and learning environment.
A location that provides treatment for substance (alcohol and drug) abuse on an ambulatory basis.
Non‑residential Substance
57 Services include individual and group therapy and counseling, family counseling, laboratory tests, drugs
Abuse Treatment Facility
and supplies, and psychological testing. (Effective 10/1/03)
58‑59 Unassigned N/A
A location where providers administer pneumococcal pneumonia and influenza virus vaccinations and
submit these services as electronic media claims, paper claims, or using the roster billing method. This
60 Mass Immunization Center
generally takes place in a mass immunization setting, such as, a public health center, pharmacy, or mall
but may include a physician office setting.
A facility that provides comprehensive rehabilitation services under the supervision of a physician to
Comprehensive Inpatient
61 inpatients with physical disabilities. Services include physical therapy, occupational therapy, speech
Rehabilitation Facility
pathology, social or psychological services, and orthotics and prosthetics services.
A facility that provides comprehensive rehabilitation services under the supervision of a physician to
Comprehensive Outpatient
62 outpatients with physical disabilities. Services include physical therapy, occupational therapy, and speech
Rehabilitation Facility
pathology services.
63‑64 Unassigned N/A
End‑Stage Renal Disease A facility other than a hospital, which provides dialysis treatment, maintenance, and/or training to
65
Treatment Facility patients or caregivers on an ambulatory or home‑care basis.
66‑70 Unassigned N/A
A facility maintained by either State or local health departments that provides ambulatory primary
71 Public Health Clinic
medical care under the general direction of a physician.
A certified facility which is located in a rural medically underserved area that provides ambulatory
72 Rural Health Clinic
primary medical care under the general direction of a physician.
73‑80 Unassigned N/A
A laboratory certified to perform diagnostic and/or clinical tests independent of an institution or a
81 Independent Laboratory
physician’s office.
82‑98 Unassigned N/A
99 Other Place of Service Other place of service not identified above.
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ii
cpt
current procedural terminology
®
2015
Professional Edition
Michelle Abraham,MHA, CCS-P DeHandro Hayden,BS Danielle Pavloski,BS, RHIT, CCS-P
Jay T. Ahlman Nadia Khalid,MJ, RHIA, RMM Desiree Rozell,MPA
Angela J. Boudreau Lia Levreau-Davis,MBA, CPC Nancy Spector,BSN, MSC
Judy Connelly Elizabeth Lumakovska,MPA, RHIT Lianne Stancik,RHIT
Rick A. Crosslin Janette Meggs,RHIA Asif A. Syed,MD, MPH
Biljana Dimovski,MS, RHM, CDC Marie L. Mindeman,BA, RHIT Ada Walker,CCA
Desiree D. Evans,AAS Karen E. O’Hara,BS, CCS-P Arletrice Watkins,MHA, RHIA
Lauren M. Feldman Mary R. O’Heron,RHIA Rejina L. Young
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Eye and Ocular Adnexa / Surgery
Foreword Acknowledgments
CurrentProcedural Terminology (CPT®), Fourth Edition, is a Publication of the annual CPT codebook represents many
listing of descriptive terms and identifying codes for reporting challenges and opportunities. From reconciling the many
medical services and procedures performed by physicians.The differences of opinion about the best way to describe a
purpose of the terminology is to provide a uniform language procedure, to the last details on placement of a semicolon, many
that will accurately describe medical, surgical, and diagnostic individuals and organizations devote their energies and expertise
services, and will thereby provide an effective means for reliable to the preparation of this revision.
nationwide communication among physicians, patients, and
The editorial staff wishes to express sincere thanks to the many
third parties.CPT 2015 is the most recent revision of a work
national medical specialty societies, health insurance
that first appeared in 1966.
organizations and agencies, and individual physicians and other
CPT descriptive terms and identifying codes currently serve a health professionals who have made contributions.
wide variety of important functions in the field of medical
Thanks are due to Robert A. Musacchio, PhD, SrVP, American
nomenclature.The CPT code set is useful for administrative
Medical Association; Claudia Bonnell, Blue Cross and Blue
management purposes such as claims processing and for the
Shield Association; Nelly Leon-Chisen, American Hospital
development of guidelines for medical care review.The uniform
Association; Sue Bowman, RHIA, American Health
language is also applicable to medical education and outcomes,
Information Management Association; and Raemarie Jiminez,
health services, and quality research by providing a useful basis
CPC, American Academy of Professional Coders, for their
for local, regional, and national utilization comparisons.The
invaluable assistance in enhancing the CPT code set.
CPT code set is the most widely accepted nomenclature for the
reporting of physician procedures and services under
government and private health insurance programs. In 2000,
the CPT code set was designated by the Department of Health
and Human Services as the national coding standard for
physician and other health care professional services and
procedures under the Health Insurance Portability and
Accountability Act (HIPAA).This means that for all financial
and administrative health care transactions sent electronically,
the CPT code set will need to be used.
The changes that appear in this revision have been prepared by
the CPT Editorial Panel with the assistance of physicians
representing all specialties of medicine, and with important
contributions from many third-party payers and governmental
agencies.
The American Medical Association trusts that this revision will
continue the usefulness of its predecessors in identifying,
describing, and coding medical, surgical, and diagnostic
services.
AmericanMedicalAssociation v
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AMA CPT Editorial Panel American Academy of Pain Medicine
Eduardo M. Fraifeld, MD
Chair
Peter A. Hollmann, MD* American Academy of Pediatrics
Vice-Chair Joel F. Bradley, Jr, MD, FAAP
Kenneth P. Brin, MD, PhD, FACC* SanjeevY.Tuli, MD, MEd, FAAP
American Academy of Physical Medicine and Rehabilitation
Albert E. Bothe, Jr, MD, FACS
Jeffrey S. Brault, DO
Boyd R. Buser, DO, FACOFP Annie D. Purcell, DO‡
Leslie F. Davidson, PhD, OTR/L
Frank J. Dubeck, Jr, MD, FACP* American Academy of Sleep Medicine
Richard Duszak, Jr, MD, FACR* Amy J. Aronsky, DO, FAASM, FCCP, CBSM
David A. Ellington, MD William C. Sherrill, Jr, MD
Ronald A. Gabel, MD
American Association for Clinical Chemistry
Edith Hambrick, MD, JD
William A. Clark, PhD, DABCC, FACB‡
Christopher L. Jagmin, MD
Katharine Krol, MD American Association forThoracic Surgery
Victor L. Lewis, Jr, MD, FACS Kirk R. Kanter, MD
Bernard A. Pfeifer, MD† Stephen J. Lahey, MD
Julia M. Pillsbury, DO, FAAP, FACOP
Antonio E. Puente, PhD American Association of Clinical Endocrinologists
Mark S. Synovec, MD* Eric A. Orzeck, MD, FACP, FACE
Secretary American Association of Neurological Surgeons
Marie L. Mindeman, BA, RHIT R. Patrick Jacob, MD
Henry H.Woo, MD, FAANS
*Member of the CPT Executive Committee
†New Panel Member American Association of Neuromuscular and Electrodiagnostic
‡New Advisors Medicine
Andrea J. Boon, MD
AMA CPT Advisory Committee
American Clinical Neurophysiology Society
American Academy of Allergy, Asthma and Immunology Marc R. Nuwer, MD, PhD, FAAN, FACP
DonaldW. Aaronson, MD, JD, MPH Ronald G. Emerson, MD
American Academy of Child & Adolescent Psychiatry American College of Allergy, Asthma and Immunology
Benjamin N. Shain, MD, PhD Gary N. Gross, MD
David I. Berland, MD
American College of Cardiology
American Academy of Dermatology Robert N. Piana, MD, FACC
Alexander Miller, MD Randall C.Thompson, MD‡
Ann F. Haas, MD
American College of Chest Physicians
American Academy of Disability Evaluating Physicians Steve G. Peters, MD
DouglasW. Martin, MD, FAADEP, FACOEM Michael E. Nelson, MD, FCCP
James B.Talmage, MD
American College of Emergency Physicians
American Academy of Family Physicians Kenneth L. DeHart, MD, FACEP
Robert J. Carr, Jr, MD Jacob Mark J. Meredith, III, MD, MMM, FACEP
Gretchen M. Dickson, MD, MBA
American College of Gastroenterology
American Academy of Neurology ChristopherY. Kim, MD, MBA, FACG, FASGE, AGAF, FACP
Marc R. Nuwer, MD, PhD, FAAN, FACP Daniel C. DeMarco, MD, FACG
Bruce H. Cohen, MD, FAAN
American College of Medical Genetics and Genomics
American Academy of Ophthalmology David B. Flannery, MD
Michael X. Repka, MD, MBA
John M. Haley, MD‡ American College of Medical Quality
Joel Grossman, MD
American Academy of Orthopaedic Surgeons
American College of Mohs Surgery
Richard J. Friedman, MD, FACSC
David B. Pharis, MD, PC
M. Bradford Henley, MD, MBA
American College of Nuclear Medicine
American Academy of Otolaryngic Allergy
Scott C. Bartley, MD
PaulT. Fass, MD, FACS
American College of Occupational and Environmental Medicine
American Academy of Otolaryngology Head and Neck Surgery
Lee S. Glass, MD, JD
Bradley F. Marple, MD, FAAOA
Lawrence M. Simon, MD, FAAP
vi CPTEditorial Panel/Advisory Committee CPT 2015
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Eye and Ocular Adnexa / Surgery
American College of Physicians American Society for Reproductive Medicine
Jeannine Z. Engel, MD, FACP DrewV. Moffitt, MD
R. Scott Hanson, MD, MPH, FACP
American Society for Surgery of the Hand
American College of Radiation Oncology Daniel J. Nagle, MD
AndyW. Su, MD Leo S. Benson, MD
Paul E.Wallner, DO, FACR, FAOCR, FASTRO, FACRO
American Society of Anesthesiologists
American College of Radiology Peter A. Goldzweig, DO
Daniel Picus, MD, FACR, RCC Kevin E.Vorenkamp, MD
Timothy A. Crummy, MD, RCC
American Society of Cataract and Refractive Surgery
American College of Rheumatology Stephen S. Lane, MD
Gerald M. Eisenberg, MD, FACP, FACR
American Society of Clinical Oncology
Robert J. Lloyd, MD, FACP, FACR
Christian A.Thomas, MD
American College of Surgeons
American Society of Colon and Rectal Surgeons
Linda M. Barney, MD, FACS
Stephen M. Sentovich, MD, MBA, FCS, FASCRS
MarkT. Savarise, MD, FACS
William J. Harb, MD, FACS
American Congress of Obstetricians and Gynecologists
American Society of Cytopathology
Jordan G. Pritzker, MD, MBA, FACOG
Carol A. Filomena, MD
Judith K.Volkar, MD‡
American Society of General Surgeons
American Dental Association
George K. Gillian, MD, FACS‡
Anthony M. Spina, DDS, MD
Christopher C. Smith, MD‡
Joshua E. Everts, DDS, MD
American Society of Hematology
American Gastroenterological Association
Samuel M. Silver, MD, PhD, FACP, FAHA
JoelV. Brill, MD, AGAF, FASGE, FACG, CHCQM
Robert Weinstein,MD
American Geriatric Society
American Society of Interventional Pain Physicians
Robert A. Zorowitz, MD, MBA, FACP, AGSF, CMD
Frank J.E. Falco, MD‡
American Institute of Ultrasound in Medicine Sachin Jha, MD, MS‡
Harvey L. Nisenbaum, MD
American Society of Neuroradiology
American Medical Directors Association Raymond K.Tu, MD
Dennis L. Stone, MD, MBA Jacqueline A. Bello, MD, FACR
American Orthopaedic Association American Society of Ophthalmic Plastic and Reconstructive Surgery
Blair C. Filler, MD L. Neal Freeman, MD, MBA, CCS-P, FACS
American Orthopaedic Foot and Ankle Society American Society of Plastic Surgeons
Walter J. Pedowitz, MD‡ RaymondV. Janevicius, MD
David I. Pedowitz, MD‡ Deborah S. Bash, MD
American Osteopathic Association American ThoracicSociety
Judith A. O’Connell, DO, FAAO Stephen P. Hoffmann, MD
Brian E. Kaufman, DO‡
American Urological Association
American Psychiatric Association Jeffrey A. Dann, MD, MBA
David K. Nace, MD Ronald P. Kaufman, Jr, MD, FACS
Jeremy S. Musher, MD
Association of University Radiologists
American Roentgen Ray Society Robert K. Zeman, MD, FACR
Mark D. Alson, MD, FACR, RCC
College of American Pathologists
American Society for Aesthetic Plastic Surgery, Inc. Michael D. McEachin, MD
Paul R.Weiss, MD
Congress of Neurological Surgeons
American Society for Clinical Pathology Joseph S. Cheng, MD
Lee H. Hilborne, MD, MPH, FASCP
Heart Rhythm Society
American Society for Dermatologic Surgery Oussama M.Wazni, MD
Murad Alam, MD Joseph E. Marine, MD‡
Jeremy S. Bordeaux, MD, MPH
Infectious Disease Society of America
American Society for Gastrointestinal Endoscopy Steven K. Schmitt, MD
Glenn D. Littenberg, MD, FACP Lyssette L. Cardona, MD, MPH, MSHA‡
American Society for Radiation Oncology International Spinal Intervention Society
David C. Beyer, MD, FACR, FACRO, FASTRO Scott I. Horn, DO
William F. Hartsell, MD‡ Claire Tibiletti,MD
AmericanMedicalAssociation vii
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National Association of Medical Examiners American Academy of Physician Assistants
John S. Denton, MD‡ Patrick J. Cafferty, MPAS, PA-C
North American Spine Society American Association of Naturopathic Physicians
William Mitchell, MD Wendell B. Milliman, ND
David R. O’Brien, Jr, MD Eva Miller, ND
Radiological Society of North America American Association for Respiratory Care
Timothy A. Crummy, MD
Susan Rinaldo-Gallo, MEd, RRT, FAARC
Renal Physicians Association
American Chiropractic Association
Chester A. Amedia, Jr, MD, FACP
Craig S. Little, DC, FACO
Timothy A. Pflederer, MD‡
Leo Bronston DC, MappSC
Society for Cardiovascular Angiography and Interventions
American MassageTherapy Association
Arthur C. Lee, MD, FSCAI
Susan B. Rosen, LPM
Society for Investigative Dermatology Nancy M. Porambo, BA, MS, LMT, NCTMB‡
Stephen P. Stone, MD
American Nurses Association
Society forVascular Surgery Jamesetta A. Newland, PhD, RN, FNP-BC, FAANP, DPMAP‡
Sean P. Roddy, MD, FACS Leslie C.Verucci, RN, MSN, CNS, CRNP, APRN-BC‡
Society of American Gastrointestinal Endoscopic Surgeons American OccupationalTherapy Association
John S. Roth, MD, FACS
Mary Jo McGuire, MS, OTR/L, FAOTA
Kevin E.Wasco, MD, FACS
Doris J. Shriver, OTR, FAOTA, QRC, CLCP‡
Society of Critical Care Medicine
American Optometric Association
George A. Sample, MD, FCCP
Douglas C. Morrow, OD
Society of Interventional Radiology Rebecca H.Wartman, OD
Donald F. Denny, Jr, MD
Timothy L. Swan, MD American PhysicalTherapy Association
Helene M. Fearon, PT
Society of Nuclear Medicine and Molecular Imaging Kathleen M. Picard, PT
Gary L. Dillehay, MD, FACNP, FACR
American Podiatric Medical Association
Society ofThoracic Surgeons
Phillip E.Ward, DPM
Francis C. Nichols, III, MD
Ira H. Kraus, DPM
Jeffrey P. Jacobs, MD, FACS, FACC, FCCP
American Psychological Association
The Endocrine Society
Neil H. Pliskin, PhD, ABPP-CN
Allan R. Glass, MD
Randy E. Phelps, PhD‡
The TriologicalSociety
Richard W. Waguespack,MD,FACS American Speech Hearing Association
Stuart G.Trembath, MA, CCC-A
United States and Canadian Academy of Pathology R.Wayne Holland, EdD, CCC-SLP
David S.Wilkinson, MD, PhD
National AthleticTrainers’ Association
AMA Health Care Professionals Karen D. Fennell, MS, ATC, LAT
WilliamT. Griffin, MA, LAT, ATC‡
Advisory Committee (HCPAC)
National Association of SocialWorkers
Peter A. Hollmann, MD*, Co-Chair Mirean F. Coleman, LICSW
AMA CPT Editorial Panel
National Society of Genetic Counselors
Antonio E. Puente, PhD, Co-Chair
Leslie H. Cohen, MS, CGC
AMA CPT Editorial Panel
Pharmacy Health InformationTechnology Collaborative
Academy of Nutrition and Dietetics
Daniel E. Buffington, PharmD, MBA
Keith-Thomas Ayoob, EdD, RN, FADA, CSP
Jessie M. Pavlianc, MS, RD, CSR, LD‡
American Academy of Audiology
Brad A. Stach, PhD
Paul M. Pessis, AuD
viii CPTEditorial Panel/Advisory Committee CPT 2015
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Contents
Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .v Evaluation and Management . . . . . . . . . . . . . . . . . . . . . . . . .11
Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .v Office or Other Outpatient Services . . . . . . . . . . . . . . . . . .11
Hospital Observation Services . . . . . . . . . . . . . . . . . . . . . .13
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xii
Hospital Inpatient Services . . . . . . . . . . . . . . . . . . . . . . . .15
Section Numbers and Their Sequences . . . . . . . . . . . . . . .xii
Consultations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19
Instructions for Use of the CPT Codebook . . . . . . . . . . . . .xii
Emergency Department Services . . . . . . . . . . . . . . . . . . . .22
Format of the Terminology . . . . . . . . . . . . . . . . . . . . xiii
Critical Care Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23
Requests to Update the CPT Nomenclature . . . . . . xiii
Nursing Facility Services . . . . . . . . . . . . . . . . . . . . . . . . . .25
Application Submission Requirements . . . . . . . . . xiii
Domiciliary, Rest Home (eg, Boarding Home),
General Criteria for Category I and Category III Codes . xiii
or Custodial Care Services . . . . . . . . . . . . . . . . . . . . . . . . .28
Category-Specific Requirements . . . . . . . . . . . . . . . xiv
Domiciliary, Rest Home (eg, Assisted Living Facility),
Guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiv or Home Care Plan Oversight Services . . . . . . . . . . . . . . .29
Add-on Codes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiv Home Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30
Modifiers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiv Prolonged Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31
Place of Service and Facility Reporting . . . . . . . . . . .xv Case Management Services . . . . . . . . . . . . . . . . . . . . . . . .33
Unlisted Procedure or Service . . . . . . . . . . . . . . . . . .xv Care Plan Oversight Services . . . . . . . . . . . . . . . . . . . . . . .34
Results, Testing, Interpretation, and Report . . . . . . .xv Preventive Medicine Services . . . . . . . . . . . . . . . . . . . . . .35
Non-Face-to-Face Services . . . . . . . . . . . . . . . . . . . . . . . . .37
Special Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xv
Special Evaluation and Management Services . . . . . . . . .39
Time . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xv
Newborn Care Services . . . . . . . . . . . . . . . . . . . . . . . . . . .40
Code Symbols . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvi
Delivery/Birthing Room Attendance and
Alphabetical Reference Index . . . . . . . . . . . . . . . . . xvi
Resuscitation Services . . . . . . . . . . . . . . . . . . . . . . . . . . . .40
CPT 2015 in Electronic Formats . . . . . . . . . . . . . . . . xvi
Inpatient Neonatal Intensive Care Services and
References to AMA Resources . . . . . . . . . . . . . . . . xvi Pediatric and Neonatal Critical Care Services . . . . . . . . . .41
Illustrated Anatomical and Procedural Review . . . . . . xvii Care Management Services . . . . . . . . . . . . . . . . . . . .45
Prefixes, Suffixes, and Roots . . . . . . . . . . . . . . . . . . . . . .xvii Transitional Care Management Services . . . . . . . . . . . . . .48
Numbers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xvii Advance Care Planning . . . . . . . . . . . . . . . . . . . . . . . .49
Surgical Procedures . . . . . . . . . . . . . . . . . . . . . . . . .xvii Other Evaluation and Management Services . . . . . . . . . .50
Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xvii Anesthesia Guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .52
Directions and Positions . . . . . . . . . . . . . . . . . . . . xviii Time Reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .52
Additional References . . . . . . . . . . . . . . . . . . . . . . . . . . xviii Anesthesia Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .52
Medical Dictionaries . . . . . . . . . . . . . . . . . . . . . . . xviii Supplied Materials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .52
Anatomy References . . . . . . . . . . . . . . . . . . . . . . . xviii Separate or Multiple Procedures . . . . . . . . . . . . . . . . . . . .52
Lists of Illustrations . . . . . . . . . . . . . . . . . . . . . . . . . . . . xviii Special Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .52
Anatomical Illustrations . . . . . . . . . . . . . . . . . . . . xviii Anesthesia Modifiers . . . . . . . . . . . . . . . . . . . . . . . . . . . . .53
Procedural Illustrations . . . . . . . . . . . . . . . . . . . . . . xix Qualifying Circumstances . . . . . . . . . . . . . . . . . . . . . . . . . .53
Evaluation and Management Tables . . . . . . . . . . . . . . . .xxii
Anesthesia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .54
Evaluation and Management (E/M) Services Guidelines .4 Head . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .54
Classification of Evaluation and Management Neck . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .54
(E/M) Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 Thorax (Chest Wall and Shoulder Girdle) . . . . . . . . . . . . . .54
Definitions of Commonly Used Terms . . . . . . . . . . . . . . . . .4 Intrathoracic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .55
Unlisted Service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 Spine and Spinal Cord . . . . . . . . . . . . . . . . . . . . . . . . . . . .55
Special Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 Upper Abdomen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .56
Clinical Examples . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 Lower Abdomen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .56
Instructions for Selecting a Level of E/M Service . . . . . . . .9 Perineum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .57
AmericanMedicalAssociation ix
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