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⌀ | Definition
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⌀ | Includes
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⌀ | Excludes
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⌀ | Guidelines
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⌀ |
|---|---|---|---|---|---|---|---|---|---|---|---|
579210000
|
57921-00-00
|
Radiography of nose
|
Radiography of nose (maxilla)
| 20
|
Imaging services
| 1,967
|
Radiography of head or neck
|
Radiography of nose (maxilla), excluding that of cervical spine.
| null |
That of Cervical Spine (58100-00-00 [1968])
| null |
579270001
|
57927-00-01
|
Radiography temporomandibular joint uni
|
Radiography of temporomandibular joint, unilateral
| 20
|
Imaging services
| 1,967
|
Radiography of head or neck
|
Except that of cervical spine.
| null |
That of Cervical Spine (58100-00-00 [1968])
Arthrography (59751-00-00 [1985])
| null |
579270002
|
57927-00-02
|
Radiography tmj bil
|
Radiography of temporomandibular joint, bilateral
| 20
|
Imaging services
| 1,967
|
Radiography of head or neck
|
Radiography of temporomandibular joint (both sides), excluding that of cervical spine and arthrography.
| null |
That of Cervical Spine (58100-00-00 [1968])
Arthrography (59751-00-00 [1985])
| null |
579300000
|
57930-00-00
|
Radiography of teeth
|
Radiography of teeth
| 20
|
Imaging services
| 1,967
|
Radiography of head or neck
|
Dental radiography, orthodontic: cephalography and cephalometry, except that of cervical spine.
|
Dental Radiography
orthodontic:
• Cephalography
• Cephalometry
|
That of Cervical Spine (58100-00-00 [1968])
That of Full Mouth (57933-00-00 [1967])
| null |
579390000
|
57939-00-00
|
Palatopharyngeal stud w fluorosc screen
|
Palatopharyngeal study with fluoroscopic screening
| 20
|
Imaging services
| 1,967
|
Radiography of head or neck
|
Except that of cervical spine.
| null |
That of Cervical Spine (58100-00-00 [1968])
| null |
579450000
|
57945-00-00
|
Radiography of larynx
|
Radiography of larynx
| 20
|
Imaging services
| 1,967
|
Radiography of head or neck
|
Except that of cervical spine.
|
Soft Tissue of Neck
|
That of Cervical Spine (58100-00-00 [1968])
| null |
579600000
|
57960-00-00
|
Orthopantomography
|
Orthopantomography
| 20
|
Imaging services
| 1,967
|
Radiography of head or neck
|
Except that of cervical spine.
| null |
That of Cervical Spine (58100-00-00 [1968])
| null |
597030000
|
59703-00-00
|
Dacryocystography
|
Dacryocystography
| 20
|
Imaging services
| 1,967
|
Radiography of head or neck
|
Except that of cervical spine.
|
Contrast
|
That of Cervical Spine (58100-00-00 [1968])
| null |
597330000
|
59733-00-00
|
Radiography salivary gland with contrast
|
Sialography with contrast
| 20
|
Imaging services
| 1,967
|
Radiography of head or neck
|
Sialography with contrast
| null |
That of Cervical Spine (58100-00-00 [1968])
| null |
909000000
|
90900-00-00
|
Encephalography
|
Encephalography
| 20
|
Imaging services
| 1,967
|
Radiography of head or neck
|
Pneumocisternography, Pneumoencephalography, except that of cervical spine.
|
Pneumocisternography
Pneumoencephalography
|
That of Cervical Spine (58100-00-00 [1968])
| null |
581000000
|
58100-00-00
|
Radiography of cervical spine
|
Radiography of cervical spine
| 20
|
Imaging services
| 1,968
|
Radiography of spine
|
Except radiography of spine: 2,3 and 4 regions.
|
Functional Views
|
Radiography of Spine:
• 2 Regions (58112-00-00 [1969])
• 3 Regions (58115-00-00 [1969])
• 4 Regions (58108-00-00 [1969])
| null |
581030000
|
58103-00-00
|
Radiography of thoracic spine
|
Radiography of thoracic spine
| 20
|
Imaging services
| 1,968
|
Radiography of spine
|
Except radiography of spine: 2,3 and 4 regions.
|
Functional Views
|
Radiography of Spine:
• 2 Regions (58112-00-00 [1969])
• 3 Regions (58115-00-00 [1969])
• 4 Regions (58108-00-00 [1969])
| null |
581060000
|
58106-00-00
|
Radiography of lumbosacral spine
|
Radiography of lumbosacral spine
| 20
|
Imaging services
| 1,968
|
Radiography of spine
|
Except radiography of spine: 2,3 and 4 regions.
|
Functional Views
|
Radiography of Spine:
• 2 Regions (58112-00-00 [1969])
• 3 Regions (58115-00-00 [1969])
• 4 Regions (58108-00-00 [1969])
| null |
581090000
|
58109-00-00
|
Radiography of sacrococcygeal spine
|
Radiography of sacrococcygeal spine
| 20
|
Imaging services
| 1,968
|
Radiography of spine
|
Except radiography of spine: 2,3 and 4 regions.
|
Functional Views
|
Radiography of Spine:
• 2 Regions (58112-00-00 [1969])
• 3 Regions (58115-00-00 [1969])
• 4 Regions (58108-00-00 [1969])
| null |
597000000
|
59700-00-00
|
Discography
|
Discography
| 20
|
Imaging services
| 1,968
|
Radiography of spine
| null |
Functional Views
| null | null |
597240000
|
59724-00-00
|
Myelography
|
Myelography
| 20
|
Imaging services
| 1,968
|
Radiography of spine
| null |
Functional Views
| null | null |
581120000
|
58112-00-00
|
Radiography of spine 2 regions
|
Radiography of spine, 2 regions
| 20
|
Imaging services
| 1,969
|
Radiography of spine, 2 regions
| null |
Functional Views
That of 2, 3 or 4 of the Following Spinal Regions:
• Cervical
• Lumbosacral
• Sacrococcygeal
• Thoracic
| null | null |
581150000
|
58115-00-00
|
Radiography of spine 3 regions
|
Radiography of spine, 3 regions
| 20
|
Imaging services
| 1,969
|
Radiography of spine, 2 regions
| null |
Functional Views
That of 2, 3 or 4 of the Following Spinal Regions:
• Cervical
• Lumbosacral
• Sacrococcygeal
• Thoracic
| null | null |
581080000
|
58108-00-00
|
Radiography of spine 4 regions
|
Radiography of spine, 4 regions
| 20
|
Imaging services
| 1,969
|
Radiography of spine, 2 regions
| null |
Functional Views
That of 2, 3 or 4 of the Following Spinal Regions:
• Cervical
• Lumbosacral
• Sacrococcygeal
• Thoracic
| null | null |
575060121
|
57506-01-21
|
Radiography elbow >=3 views uni
|
Radiography of elbow, 3 or more views, unilateral
| 20
|
Imaging services
| 1,970
|
Radiography of shoulder region
|
Radiography of elbow, 3 or more view (one side), excluding hand, wrist, shoulder or scapula.
| null | null | null |
575060122
|
57506-01-22
|
Radiography elbow >=3 views bil
|
Radiography of elbow, 3 or more views, bilateral
| 20
|
Imaging services
| 1,970
|
Radiography of shoulder region
|
Radiography of elbow, 3 or more view (both sides), excluding hand, wrist, shoulder or scapula.
| null | null | null |
575060321
|
57506-03-21
|
Radiography wrist >=3 views uni
|
Radiography of wrist, 3 or more views, unilateral
| 20
|
Imaging services
| 1,970
|
Radiography of shoulder region
|
Radiography of wrist, 3 or more view (one side), excluding hand, elbow, shoulder or scapula.
| null | null | null |
575060322
|
57506-03-22
|
Radiography wrist >=3 views bil
|
Radiography of wrist, 3 or more views, bilateral
| 20
|
Imaging services
| 1,970
|
Radiography of shoulder region
|
Radiography of wrist, 3 or more view (both sides), excluding hand, elbow, shoulder or scapula.
| null | null | null |
575060421
|
57506-04-21
|
Radiography hand >=3 views uni
|
Radiography of hand, 3 or more views, unilateral
| 20
|
Imaging services
| 1,970
|
Radiography of shoulder region
|
Radiography of hand, 3 or more view (one side), excluding wrist, elbow, shoulder or scapula.
| null | null | null |
575060422
|
57506-04-22
|
Radiography hand >=3 views bil
|
Radiography of hand, 3 or more views, bilateral
| 20
|
Imaging services
| 1,970
|
Radiography of shoulder region
|
Radiography of hand, 3 or more view (both sides), excluding wrist, elbow, shoulder or scapula.
| null | null | null |
577000011
|
57700-00-11
|
Radiography shoulder/scapula 1 vw uni
|
Radiography of shoulder or scapula, 1 view, unilateral
| 20
|
Imaging services
| 1,970
|
Radiography of shoulder region
|
Radiography of shoulder or scapula, 1 view (one side).
| null | null | null |
577000012
|
57700-00-12
|
Radiography shoulder /scapula 1 vw bil
|
Radiography of shoulder or scapula, 1 view, bilateral
| 20
|
Imaging services
| 1,970
|
Radiography of shoulder region
|
Radiography of shoulder or scapula, 1 view (both sides).
| null | null | null |
577000021
|
57700-00-21
|
Radiography shoulder/scapula 2 /more views uni
|
Radiography of shoulder or scapula, 2 or more views, unilateral
| 20
|
Imaging services
| 1,970
|
Radiography of shoulder region
|
Radiography of shoulder or scapula, 2 or more views (one side).
| null | null | null |
577000022
|
57700-00-22
|
Radiography shoulder/scapula 2/more views bil
|
Radiography of shoulder or scapula, 2 or more views, bilateral
| 20
|
Imaging services
| 1,970
|
Radiography of shoulder region
|
Radiography of shoulder or scapula, 2 or more views (both sides).
| null | null | null |
577060001
|
57706-00-01
|
Radiography clavicle uni
|
Radiography of clavicle, unilateral
| 20
|
Imaging services
| 1,970
|
Radiography of shoulder region
|
Radiography of clavicle (one side).
| null | null | null |
577060002
|
57706-00-02
|
Radiography clavicle bil
|
Radiography of clavicle, bilateral
| 20
|
Imaging services
| 1,970
|
Radiography of shoulder region
|
Radiography of clavicle (both sides).
| null | null | null |
575060001
|
57506-00-01
|
Radiography humerus uni
|
Radiography of humerus, unilateral
| 20
|
Imaging services
| 1,971
|
Radiography of upper limb
|
Radiography of humerus (one side).
| null | null | null |
575060002
|
57506-00-02
|
Radiography humerus bil
|
Radiography of humerus, bilateral
| 20
|
Imaging services
| 1,971
|
Radiography of upper limb
|
Radiography of humerus (both sides).
| null | null | null |
575060111
|
57506-01-11
|
Radiography elbow 1 or 2 views uni
|
Radiography of elbow, 1 or 2 views, unilateral
| 20
|
Imaging services
| 1,971
|
Radiography of upper limb
|
Radiography of elbow, 1 or 2 views (one side).
| null | null | null |
575060112
|
57506-01-12
|
Radiography elbow 1 or 2 views bil
|
Radiography of elbow, 1 or 2 views, bilateral
| 20
|
Imaging services
| 1,971
|
Radiography of upper limb
|
Radiography of elbow, 1 or 2 views (both sides).
| null | null | null |
575060201
|
57506-02-01
|
Radiography forearm uni
|
Radiography of forearm, unilateral
| 20
|
Imaging services
| 1,971
|
Radiography of upper limb
|
Radiography of forearm (one side).
| null | null | null |
575060202
|
57506-02-02
|
Radiography forearm bil
|
Radiography of forearm, bilateral
| 20
|
Imaging services
| 1,971
|
Radiography of upper limb
|
Radiography of forearm (both sides).
| null | null | null |
575060311
|
57506-03-11
|
Radiography wrist 1 or 2 views uni
|
Radiography of wrist, 1 or 2 views, unilateral
| 20
|
Imaging services
| 1,971
|
Radiography of upper limb
|
Except bone age study of wrist and knee.
| null |
Bone Age Study of Wrist and Knee (58300-00-00 [1984])
| null |
575060312
|
57506-03-12
|
Radiography wrist 1 or 2 views bil
|
Radiography of wrist, 1 or 2 views, bilateral
| 20
|
Imaging services
| 1,971
|
Radiography of upper limb
|
Except bone age study of wrist and knee.
| null |
Bone Age Study of Wrist and Knee (58300-00-00 [1984])
| null |
575060411
|
57506-04-11
|
Radiography hand 1 or 2 views uni
|
Radiography of hand, 1 or 2 views, unilateral
| 20
|
Imaging services
| 1,971
|
Radiography of upper limb
|
Radiography of hand, 1 or 2 views (one side).
| null | null | null |
575060412
|
57506-04-12
|
Radiography hand 1 or 2 views bil
|
Radiography of hand, 1 or 2 views, bilateral
| 20
|
Imaging services
| 1,971
|
Radiography of upper limb
|
Radiography of hand, 1 or 2 views (both sides).
| null | null | null |
575120001
|
57512-00-01
|
Radiography elbow & humerus uni
|
Radiography of elbow and humerus, unilateral
| 20
|
Imaging services
| 1,971
|
Radiography of upper limb
|
Radiography of elbow and humerus (one side), excluding forearm.
| null | null | null |
575120002
|
57512-00-02
|
Radiography elbow & humerus bil
|
Radiography of elbow and humerus, bilateral
| 20
|
Imaging services
| 1,971
|
Radiography of upper limb
|
Radiography of elbow and humerus (both sides), excluding forearm.
| null | null | null |
575120101
|
57512-01-01
|
Radiography elbow & forearm uni
|
Radiography of elbow and forearm, unilateral
| 20
|
Imaging services
| 1,971
|
Radiography of upper limb
|
Radiography of elbow and forearm (one side).
| null | null | null |
575120102
|
57512-01-02
|
Radiography elbow & forearm bil
|
Radiography of elbow and forearm, bilateral
| 20
|
Imaging services
| 1,971
|
Radiography of upper limb
|
Radiography of elbow and forearm (both sides).
| null | null | null |
575120201
|
57512-02-01
|
Radiography hand wrist & forearm uni
|
Radiography of hand, wrist and forearm, unilateral
| 20
|
Imaging services
| 1,971
|
Radiography of upper limb
|
Radiography of hand, wrist and forearm (one side).
| null | null | null |
575120202
|
57512-02-02
|
Radiography hand wrist & forearm bil
|
Radiography of hand, wrist and forearm, bilateral
| 20
|
Imaging services
| 1,971
|
Radiography of upper limb
|
Radiography of hand, wrist and forearm (both sides).
| null | null | null |
575120301
|
57512-03-01
|
Radiography hand & wrist uni
|
Radiography of hand and wrist, unilateral
| 20
|
Imaging services
| 1,971
|
Radiography of upper limb
|
Radiography of hand and wrist (one side) without the forearm.
| null | null | null |
575120302
|
57512-03-02
|
Radiography hand & wrist bil
|
Radiography of hand and wrist, bilateral
| 20
|
Imaging services
| 1,971
|
Radiography of upper limb
|
Radiography of hand and wrist (both sides) without the forearm.
| null | null | null |
585210000
|
58521-00-00
|
Radiography of sternum
|
Radiography of sternum
| 20
|
Imaging services
| 1,972
|
Radiography of sternum or ribs
|
Radiography of sternum.
| null | null | null |
585210100
|
58521-01-00
|
Radiography of ribs unilateral
|
Radiography of ribs, unilateral
| 20
|
Imaging services
| 1,972
|
Radiography of sternum or ribs
|
Radiography of ribs (one side).
| null | null | null |
585240000
|
58524-00-00
|
Radiography of ribs bilateral
|
Radiography of ribs, bilateral
| 20
|
Imaging services
| 1,972
|
Radiography of sternum or ribs
|
Radiography of ribs (both sides).
| null | null | null |
585240100
|
58524-01-00
|
Radiography of sternum & ribs unilateral
|
Radiography of sternum and ribs, unilateral
| 20
|
Imaging services
| 1,972
|
Radiography of sternum or ribs
|
Radiography of sternum and ribs (one side).
| null | null | null |
585270000
|
58527-00-00
|
Radiography of sternum & ribs bilateral
|
Radiography of sternum and ribs, bilateral
| 20
|
Imaging services
| 1,972
|
Radiography of sternum or ribs
|
Radiography of sternum and ribs (both sides).
| null | null | null |
593000000
|
59300-00-00
|
Radiography of breast bilateral
|
Radiography of breast, bilateral
| 20
|
Imaging services
| 1,973
|
Radiography of breast
|
Mammography, except mammary ductography .
| null |
Mammary Ductography (59309-00-00 [1973])
| null |
593000100
|
59300-01-00
|
Radiography breast w thermography bil
|
Radiography of breast with thermography, bilateral
| 20
|
Imaging services
| 1,973
|
Radiography of breast
|
Mammography
|
Mammography
| null | null |
593030000
|
59303-00-00
|
Radiography of breast unilateral
|
Radiography of breast, unilateral
| 20
|
Imaging services
| 1,973
|
Radiography of breast
|
Mammography, except mammary ductography .
| null |
Mammary Ductography (59306-00-00 [1973])
| null |
593030100
|
59303-01-00
|
Radiography breast w thermography uni
|
Radiography of breast with thermography, unilateral
| 20
|
Imaging services
| 1,973
|
Radiography of breast
|
Mammography
|
Mammography
| null | null |
593060000
|
59306-00-00
|
Mammary ductography of breast unilateral
|
Mammary ductography of breast, unilateral
| 20
|
Imaging services
| 1,973
|
Radiography of breast
|
Galactography of breasts, unilateral, and mammography.
|
Galactography of Breast, Unilateral
Mammography
| null | null |
593090000
|
59309-00-00
|
Mammary ductography of breast bilateral
|
Mammary ductography of breast, bilateral
| 20
|
Imaging services
| 1,973
|
Radiography of breast
|
Galactography of breasts, bilateral, and mammography.
|
Galactography of Breasts, Bilateral
Mammography
| null | null |
585000010
|
58500-00-10
|
Radiography chest 1 view
|
Radiography of chest, 1 view
| 20
|
Imaging services
| 1,974
|
Other radiography of chest
|
Except that of: ribs, sternum, thoracic inlet and trachea.
|
Bronchus
Diaphragm
Heart
Lung
Mediastinum
|
That of:
• Ribs (58521-01-00, 58524-00-00 [1972])
• Sternum (58521-00-00 [1972])
• Thoracic Inlet (58509-00-00 [1974])
• Trachea (58509-00-00 [1974])
| null |
585000020
|
58500-00-20
|
Radiography chest 2 views
|
Radiography of chest, 2 views
| 20
|
Imaging services
| 1,974
|
Other radiography of chest
|
Except that of: ribs, sternum, thoracic inlet and trachea.
|
Bronchus
Diaphragm
Heart
Lung
Mediastinum
|
That of:
• Ribs (58521-01-00, 58524-00-00 [1972])
• Sternum (58521-00-00 [1972])
• Thoracic Inlet (58509-00-00 [1974])
• Trachea (58509-00-00 [1974])
| null |
585000030
|
58500-00-30
|
Radiography chest 3 views
|
Radiography of chest, 3 views
| 20
|
Imaging services
| 1,974
|
Other radiography of chest
|
Except that of: ribs, sternum, thoracic inlet and trachea.
|
Bronchus
Diaphragm
Heart
Lung
Mediastinum
|
That of:
• Ribs (58521-01-00, 58524-00-00 [1972])
• Sternum (58521-00-00 [1972])
• Thoracic Inlet (58509-00-00 [1974])
• Trachea (58509-00-00 [1974])
| null |
585000040
|
58500-00-40
|
Radiography chest 4/ more views
|
Radiography of chest, 4 or more views
| 20
|
Imaging services
| 1,974
|
Other radiography of chest
|
Except that of: ribs, sternum, thoracic inlet and trachea.
|
Bronchus
Diaphragm
Heart
Lung
Mediastinum
|
That of:
• Ribs (58521-01-00, 58524-00-00 [1972])
• Sternum (58521-00-00 [1972])
• Thoracic Inlet (58509-00-00 [1974])
• Trachea (58509-00-00 [1974])
| null |
585060000
|
58506-00-00
|
Radiography chest w/ fluoroscopic screen
|
Radiography of chest with fluoroscopic screening
| 20
|
Imaging services
| 1,974
|
Other radiography of chest
| null |
Bronchus
Diaphragm
Heart
Lung
Mediastinum
| null | null |
585060010
|
58506-00-10
|
Fluoroscopy radiography chest
|
Fluoroscopy for radiography of the chest
| 20
|
Imaging services
| 1,974
|
Other radiography of chest
| null |
Bronchus
Diaphragm
Heart
Lung
Mediastinum
| null | null |
585090000
|
58509-00-00
|
Radiography of thoracic inlet or trachea
|
Radiography of thoracic inlet or trachea
| 20
|
Imaging services
| 1,974
|
Other radiography of chest
|
Radiography of thoracic inlet or trachea.
| null | null | null |
597150000
|
59715-00-00
|
Bronchography
|
Bronchography
| 20
|
Imaging services
| 1,974
|
Other radiography of chest
|
Endotracheal bronchography
|
Endotracheal Bronchography
| null | null |
589210000
|
58921-00-00
|
Other opaque enema
|
Other opaque enema
| 20
|
Imaging services
| 1,975
|
Radiography of gastrointestinal tract
|
Except noncontrast radiography of abdomen.
|
Air Contrast Study
Preliminary Plain Film
|
Noncontrast Radiography of Abdomen (58900 [1977])
| null |
589210010
|
58921-00-10
|
Opaque meal large intestine
|
Opaque meal of large intestine
| 20
|
Imaging services
| 1,975
|
Radiography of gastrointestinal tract
|
Opaque meal of large intestine.
| null | null | null |
589090000
|
58909-00-00
|
Opaque meal phrynx/oesoph/stomch/duodnm
|
Opaque meal of pharynx, oesophagus, stomach or duodenum
| 20
|
Imaging services
| 1,975
|
Radiography of gastrointestinal tract
|
Barium meal of pharynx, oesophagus, stomach or duodenum, except noncontrast radiography of abdomen.
|
Preliminary Plain Film
|
Noncontrast Radiography of Abdomen (58900 [1977])
Opaque Meal of Oesophagus, Stomach and Duodenum with Follow Through to Colon (58912-00-00 [1975])
| null |
589090100
|
58909-01-00
|
Opaque meal to stomch/duodnm w radiogr
|
Opaque meal of pharynx, oesophagus, stomach or duodenum with screening radiography of chest
| 20
|
Imaging services
| 1,975
|
Radiography of gastrointestinal tract
|
Barium meal of pharynx, oesophagus, stomach or duodenum with screening radiography of chest, except noncontrast radiography of abdomen.
|
Preliminary Plain Film
|
Noncontrast Radiography of Abdomen (58900 [1977])
Opaque Meal of Oesophagus, Stomach and Duodenum with Follow Through to Colon (58912-00-00 [1975])
| null |
589120000
|
58912-00-00
|
Opaque meal pharynx through to colon
|
Opaque meal of oesophagus, stomach and duodenum and follow through to colon
| 20
|
Imaging services
| 1,975
|
Radiography of gastrointestinal tract
|
Barium meal of pharynx, oesophagus, stomach and duodenum and follow through to colon, except noncontrast radiography of abdomen.
| null |
Noncontrast Radiography of Abdomen (58900 [1977])
| null |
589120100
|
58912-01-00
|
Opaq meal & thru to colon w radiogr chst
|
Opaque meal of oesophagus, stomach and duodenum and follow through to colon with screening radiography of chest
| 20
|
Imaging services
| 1,975
|
Radiography of gastrointestinal tract
|
Barium meal of oesophagus, stomach and duodenum and follow through to colon with screening radiography of chest, except noncontrast radiography of abdomen.
| null |
Noncontrast Radiography of Abdomen (58900 [1977])
| null |
589150000
|
58915-00-00
|
Opaque meal of small intestine
|
Opaque meal of small intestine
| 20
|
Imaging services
| 1,975
|
Radiography of gastrointestinal tract
|
Small bowel series, except noncontrast radiography of abdomen.
|
Preliminary Plain Film
|
Noncontrast Radiography of Abdomen (58900 [1977])
That of Duodenum (58909 [1975])
| null |
589160000
|
58916-00-00
|
Opaque enema of small intestine
|
Opaque enema of small intestine
| 20
|
Imaging services
| 1,975
|
Radiography of gastrointestinal tract
|
Barium enema of small intestine, except noncontrast radiography of abdomen.
|
Duodenal Intubation
Preliminary Plain Film
|
Noncontrast Radiography of Abdomen (58900 [1977])
That for Reduction of Intussusception (14212-00-00 [1898])
| null |
589390000
|
58939-00-00
|
Defaecography
|
Defaecography
| 20
|
Imaging services
| 1,975
|
Radiography of gastrointestinal tract
|
Except noncontrast radiography of abdomen.
| null |
Noncontrast Radiography of Abdomen (58900 [1977])
| null |
909060000
|
90906-00-00
|
Ileal conduitography
|
Ileal conduitography
| 20
|
Imaging services
| 1,975
|
Radiography of gastrointestinal tract
|
Except noncontrast radiography of abdomen.
| null |
Noncontrast Radiography of Abdomen (58900 [1977])
| null |
589240000
|
58924-00-00
|
Cholecystography
|
Cholecystography
| 20
|
Imaging services
| 1,976
|
Radiography of biliary tract
|
Graham's test, except intraoperative cholangiography, noncontrast radiography of abdomen.
|
Preliminary Plain Film
tomography
|
Intraoperative Cholangiography (30439-00-00 [957])
Noncontrast Radiography of Abdomen (58900 [1977])
| null |
589270000
|
58927-00-00
|
Direct cholangiography postoperative
|
Direct cholangiography, postoperative
| 20
|
Imaging services
| 1,976
|
Radiography of biliary tract
|
Cholangiography with dye injected directly into a tube left in biliary tract after surgery
|
Cholangiography with Dye Injected Directly Into A Tube Left In Biliary Tract After Surgery
| null | null |
589360000
|
58936-00-00
|
Drip infusion cholangiography
|
Drip infusion cholangiography
| 20
|
Imaging services
| 1,976
|
Radiography of biliary tract
|
Cholangiography NOS, Intravenous cholangiography.
|
Cholangiography Nos
Intravenous Cholangiography
| null | null |
589000010
|
58900-00-10
|
Radiography abdo single anteropost view
|
Radiography of abdomen, single anteroposterior view
| 20
|
Imaging services
| 1,977
|
Radiography of abdomen
| null |
Biliary Tract
Lower Gastrointestinal Region
Retroperitoneum
Stomach
|
That of Urinary Tract (58700-00-00 [1980])
| null |
589000020
|
58900-00-20
|
Radiography abdo anteropost & addtl oblique & cone views
|
Radiography of abdomen, anteroposterior and additional oblique and cone views
| 20
|
Imaging services
| 1,977
|
Radiography of abdomen
| null |
Biliary Tract
Lower Gastrointestinal Region
Retroperitoneum
Stomach
|
That of Urinary Tract (58700-00-00 [1980])
| null |
589000030
|
58900-00-30
|
Radiog abd cmplt incl decubit and/or erct veiws
|
Radiography of abdomen, complete, including decubitus and/or erect views
| 20
|
Imaging services
| 1,977
|
Radiography of abdomen
| null |
Biliary Tract
Lower Gastrointestinal Region
Retroperitoneum
Stomach
|
That of Urinary Tract (58700-00-00 [1980])
| null |
589000040
|
58900-00-40
|
Radiog abd cmplt incl supn erect/decub vws sngle view chst
|
Radiography of abdomen, complete, including supine, erect, and/or decubitus views, single view chest
| 20
|
Imaging services
| 1,977
|
Radiography of abdomen
| null |
Biliary Tract
Lower Gastrointestinal Region
Retroperitoneum
Stomach
|
That of Urinary Tract (58700-00-00 [1980])
| null |
589000090
|
58900-00-90
|
Radiography abdo
|
Radiography of abdomen
| 20
|
Imaging services
| 1,977
|
Radiography of abdomen
| null |
Biliary Tract
Lower Gastrointestinal Region
Retroperitoneum
Stomach
|
That of Urinary Tract (58700-00-00 [1980])
| null |
597600000
|
59760-00-00
|
Peritoneography
|
Peritoneography
| 20
|
Imaging services
| 1,977
|
Radiography of abdomen
| null |
Contrast Medium
|
Herniography
| null |
587060000
|
58706-00-00
|
Intravenous pyelography
|
Intravenous pyelography
| 20
|
Imaging services
| 1,978
|
Intravenous pyelography [IVP]
|
Infusion pyelogram
|
Infusion Pyelogram
Preliminary Plain Film
tomography
| null | null |
587150100
|
58715-01-00
|
Retrograde pyelography
|
Retrograde pyelography
| 20
|
Imaging services
| 1,979
|
Retrograde radiography of urinary system
|
Retrograde pyelography.
| null | null | null |
587180000
|
58718-00-00
|
Retrograde cystography
|
Retrograde cystography
| 20
|
Imaging services
| 1,979
|
Retrograde radiography of urinary system
|
Retrograde cystography.
| null | null | null |
587180100
|
58718-01-00
|
Retrograde urethrography
|
Retrograde urethrography
| 20
|
Imaging services
| 1,979
|
Retrograde radiography of urinary system
|
Retrograde urethrography.
| null | null | null |
587210000
|
58721-00-00
|
Retrograde micturating CUG
|
Retrograde micturating cystourethrography
| 20
|
Imaging services
| 1,979
|
Retrograde radiography of urinary system
|
Retrograde micturating cystourethrography.
| null | null | null |
587000000
|
58700-00-00
|
Radiography of urinary tract
|
Radiography of urinary tract
| 20
|
Imaging services
| 1,980
|
Other radiography of urinary system
|
Plain renal x-ray, except contrast: cystography, cystourethrography, pyelography and urethrography.
|
Bladder
Kidney
Ureter
Urethra
|
Contrast:
• Cystography (58718-00 [1979])
• Cystourethrography (58721-00-00 [1979])
• Pyelography (58706-00-00 [1978], 58715 [1979] and [1980])
• Urethrography (58718-01-00 [1979])
| null |
587150000
|
58715-00-00
|
Antegrade pyelography
|
Antegrade pyelography
| 20
|
Imaging services
| 1,980
|
Other radiography of urinary system
|
Nephrostogram, Pyelostogram.
|
Nephrostogram
Pyelostogram
| null | null |
577120011
|
57712-00-11
|
Radiography hip joint 1 view uni
|
Radiography of hip joint, 1 view, unilateral
| 20
|
Imaging services
| 1,981
|
Radiography of pelvis
|
Except contrast arthrography and that of neck of femur.
| null |
Contrast Arthrography (59751-00-00 [1985])
That of Neck of Femur (57518-00-11, 57518-00-12, 57518-00-21, 57518-00-22 [1983])
| null |
577120012
|
57712-00-12
|
Radiography hip joint 1 view bil
|
Radiography of hip joint, 1 view, bilateral
| 20
|
Imaging services
| 1,981
|
Radiography of pelvis
|
Except contrast arthrography and that of neck of femur.
| null |
Contrast Arthrography (59751-00-00 [1985])
That of Neck of Femur (57518-00-11, 57518-00-12, 57518-00-21, 57518-00-22 [1983])
| null |
577120021
|
57712-00-21
|
Radiography hip joint 2-3 views uni
|
Radiography of hip joint, 2-3 views, unilateral
| 20
|
Imaging services
| 1,981
|
Radiography of pelvis
|
Except contrast arthrography and that of neck of femur.
| null |
Contrast Arthrography (59751-00-00 [1985])
That of Neck of Femur (57518-00-11, 57518-00-12, 57518-00-21, 57518-00-22 [1983])
| null |
577120022
|
57712-00-22
|
Radiography hip joint 2-3 views bil
|
Radiography of hip joint, 2-3 views, bilateral
| 20
|
Imaging services
| 1,981
|
Radiography of pelvis
|
Except contrast arthrography and that of neck of femur.
| null |
Contrast Arthrography (59751-00-00 [1985])
That of Neck of Femur (57518-00-11, 57518-00-12, 57518-00-21, 57518-00-22 [1983])
| null |
577120031
|
57712-00-31
|
Radiography hip joint 4/more views uni
|
Radiography of hip joint, 4 or more views, unilateral
| 20
|
Imaging services
| 1,981
|
Radiography of pelvis
|
Except contrast arthrography and that of neck of femur.
| null |
Contrast Arthrography (59751-00-00 [1985])
That of Neck of Femur (57518-00-11, 57518-00-12, 57518-00-21, 57518-00-22 [1983])
| null |
577120032
|
57712-00-32
|
Radiography hip joint 4/more views bil
|
Radiography of hip joint, 4 or more views, bilateral
| 20
|
Imaging services
| 1,981
|
Radiography of pelvis
|
Except contrast arthrography and that of neck of femur.
| null |
Contrast Arthrography (59751-00-00 [1985])
That of Neck of Femur (57518-00-11, 57518-00-12, 57518-00-21, 57518-00-22 [1983])
| null |
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