Site of Service Rules for Medicare Effective April 1, 2021

10120

Incision and removal of foreign body, subcutaneous tissues; simple

10140

Incision and drainage of hematoma, seroma or fluid collection

11400

Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 0.5 cm or less

11401

Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 0.6 to 1.0 cm

11402

Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 1.1 to 2.0 cm

11403

Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 2.1 to 3.0 cm

11404

Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 3.1 to 4.0 cm

11406

Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter over 4.0 cm

11420

Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 0.5 cm or less

11421

Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 0.6 to 1.0 cm

11422

Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 1.1 to 2.0 cm

11423

Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 2.1 to 3.0 cm

11424

Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm

11426

Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm

11442

Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 1.1 to 2.0 cm

13101

Repair, complex, trunk; 2.6 cm to 7.5 cm

13132

Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 2.6 cm to 7.5 cm

14040

Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; defect 10 sq cm or less

14060

Adjacent tissue transfer or rearrangement, eyelids, nose, ears and/or lips; defect 10 sq cm or less

14301

Adjacent tissue transfer or rearrangement, any area; defect 30.1 sq cm to 60.0 sq cm

19000

Puncture aspiration of cyst of breast;

20680

Removal of implant; deep (eg, buried wire, pin, screw, metal band, nail, rod or plate)

21320

Closed treatment of nasal bone fracture; with stabilization

21552

Excision, tumor, soft tissue of neck or anterior thorax, subcutaneous; 3 cm or greater

21931

Excision, tumor, soft tissue of back or flank, subcutaneous; 3 cm or greater

27096

Injection procedure for sacroiliac joint, anesthetic/steroid, with image guidance (fluoroscopy or CT) including arthrography when performed

30140

Submucous resection inferior turbinate, partial or complete, any method

30520

Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft

31579

Laryngoscopy, flexible or rigid telescopic, with stroboscopy

42821

Tonsillectomy and adenoidectomy; age 12 or over

42825

Tonsillectomy, primary or secondary; younger than age 12

42826

Tonsillectomy, primary or secondary; age 12 or over

42830

Adenoidectomy, primary; younger than age 12

43235

Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)

43239

Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple

43249

Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic balloon dilation of esophagus (less than 30 mm diameter)

45300

Proctosigmoidoscopy, rigid; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)

45330

Sigmoidoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)

45378

Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)

45380

Colonoscopy, flexible; with biopsy, single or multiple

45384

Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps

45385

Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique

46922

Destruction of lesion(s), anus (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; surgical excision

47000

Biopsy of liver, needle; percutaneous

49505

Repair initial inguinal hernia, age 5 years or older; reducible

49585

Repair umbilical hernia, age 5 years or older; reducible

49587

Repair umbilical hernia, age 5 years or older; incarcerated or strangulated

49650

Laparoscopy, surgical; repair initial inguinal hernia

49651

Laparoscopy, surgical; repair recurrent inguinal hernia

49652

Laparoscopy, surgical, repair, ventral, umbilical, spigelian or epigastric hernia (includes mesh insertion, when performed); reducible

49653

Laparoscopy, surgical, repair, ventral, umbilical, spigelian or epigastric hernia (includes mesh insertion, when performed); incarcerated or strangulated

49654

Laparoscopy, surgical, repair, incisional hernia (includes mesh insertion, when performed); reducible

49655

Laparoscopy, surgical, repair, incisional hernia (includes mesh insertion, when performed); incarcerated or strangulated

50590

Lithotripsy, extracorporeal shock wave

52000

Cystourethroscopy (separate procedure)

52005

Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service;

52204

Cystourethroscopy, with biopsy(s)

52224

Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) or treatment of MINOR (less than 0.5 cm) lesion(s) with or without biopsy

52234

Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of; SMALL bladder tumor(s) (0.5 up to 2.0 cm)

52235

Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of; MEDIUM bladder tumor(s) (2.0 to 5.0 cm)

52260

Cystourethroscopy, with dilation of bladder for interstitial cystitis; general or conduction (spinal) anesthesia

52281

Cystourethroscopy, with calibration and/or dilation of urethral stricture or stenosis, with or without meatotomy, with or without injection procedure for cystography, male or female

52310

Cystourethroscopy, with removal of foreign body, calculus, or ureteral stent from urethra or bladder (separate procedure); simple

52332

Cystourethroscopy, with insertion of indwelling ureteral stent (eg, Gibbons or double-J type)

52351

Cystourethroscopy, with ureteroscopy and/or pyeloscopy; diagnostic

52352

Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with removal or manipulation of calculus (ureteral catheterization is included)

52353

Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy (ureteral catheterization is included)

52356

Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy including insertion of indwelling ureteral stent (eg, Gibbons or double-J type)

54161

Circumcision, surgical excision other than clamp, device, or dorsal slit; older than 28 days of age

55040

Vasotomy, cannulization with or without incision of vas, unilateral or bilateral (separate procedure)

55250

Vasectomy, unilateral or bilateral (separate procedure), including postoperative semen examination(s)

55700

Biopsy, prostate; needle or punch, single or multiple, any approach

57288

Sling operation for stress incontinence (eg, fascia or synthetic)

57460

Colposcopy of the cervix including upper/adjacent vagina; with loop electrode biopsy(s) of the cervix

57522

Conization of cervix, with or without fulguration, with or without dilation and curettage, with or without repair; loop electrode excision

58353

Endometrial ablation, thermal, without hysteroscopic guidance

58558

Hysteroscopy, surgical; with sampling (biopsy) of endometrium and/or polypectomy, with or without D & C

58563

Hysteroscopy, surgical; with endometrial ablation (eg, endometrial resection, electrosurgical ablation, thermoablation)

58565

Hysteroscopy, surgical; with bilateral fallopian tube cannulation to induce occlusion by placement of permanent implants

64520

Injection, anesthetic agent; lumbar or thoracic (paravertebral sympathetic)

64633

Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, single facet joint

64635

Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, single facet joint

64721

Neuroplasty and/or transposition; median nerve at carpal tunnel

65426

Excision or transposition of pterygium; with graft

65730

Keratoplasty (corneal transplant); penetrating (except in aphakia or pseudophakia) Revised

65855

Trabeculoplasty by laser surgery

66170

Severing adhesions of anterior segment of eye, incisional technique (with or without injection of air or liquid) (separate procedure); anterior synechiae, except goniosynechiae

66761

Iridotomy/iridectomy by laser surgery (eg, for glaucoma) (per session)

66821

Discission of secondary membranous cataract (opacified posterior lens capsule and/or anterior hyaloid); laser surgery (eg, YAG laser) (1 or more stages)

66982

Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification), complex, requiring devices or techniques not generally used in routine cataract surgery (eg, iris expansion device, suture support for intraocular lens, or primary posterior capsulorrhexis) or performed on patients in the amblyogenic developmental stage

66984

Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification)

67028

Intravitreal injection of a pharmacologic agent (separate procedure)

67036

Vitrectomy, mechanical, pars plana approach;

67040

Vitrectomy, mechanical, pars plana approach; with endolaser panretinal photocoagulation

67228

Treatment of extensive or progressive retinopathy (eg, diabetic retinopathy), photocoagulation

67311

Strabismus surgery, recession or resection procedure; 1 horizontal muscle

67312

Strabismus surgery, recession or resection procedure; 2 horizontal muscles

69436

Tympanostomy (requiring insertion of ventilating tube), general anesthesia

69631

Tympanoplasty without mastoidectomy (including canalplasty, atticotomy and/or middle ear surgery), initial or revision; without ossicular chain reconstruction