• CPT 82565 will not be separately reimbursed when submitted with CPT 80050.
• CPT 11101 will not be separately reimbursed when submitted with CPT 17000.
• CPT 36415 will not be separately reimbursed when submitted with the following CPT codes:
80048 82105 82627 83540 84550 85652
80050 82150 82670 83655 84702 86304
80051 82247 82728 84132 84703 86308
80053 82306 82785 84144 85007 86592
80055 82310 82947 84146 85014 86677
80061 82330 82948 84153 85018 86703
80069 82465 82950 84403 85025
80074 82550 82951 84436 85027
80076 82565 82962 84439 85060
80164 82575 83001 84443 85610
82040 82607 83036 84450 85651
• CPT 36416 will not be separately reimbursed when submitted with the following CPT codes:
80053 82465 82962 83655 85018 85610
80061 82947 83036 85013 85025
82247 82948 83540 85014 85027
• CPT 36540 will not be separately reimbursed when submitted with the following CPT codes:
80053 85025
• CPT 71010 will not be separately reimbursed when submitted with the following CPT codes:
99284 99285
• CPT 71020 will not be separately reimbursed when submitted with the following CPT codes:
99283 99284 99285
*The policies and guidelines addressed above are not an all-inclusive listing.
• CPT 74022 will not be separately reimbursed when submitted with CPT 99285.
• CPT 77417 will not be separately reimbursed when submitted with CPT 77427.
• CPT 78890 will not be separately reimbursed when submitted with CPT 93015.
• CPT 90760 will not be separately reimbursed when submitted with CPT 99291.
• CPT 90765 will not be separately reimbursed when submitted with CPT 99291.
• CPT 93010 will not be separately reimbursed when submitted with the following CPT codes:
92980 99232 99254 99291
99223 99233 99255
• CPT 93041 will not be separately reimbursed when submitted with CPT A0427.
• CPT 93042 will not be separately reimbursed when submitted with the following CPT codes:
99232 99233
• CPT 93508 will not be separately reimbursed when submitted with CPT 92980.
• CPT 94150 will not be separately reimbursed when submitted with the following CPT codes:
94620 95117 99214
• CPT 94760 will not be separately reimbursed when submitted with the following CPT codes:
36415 93010 99212 99215 99284
80051 99203 99213 99244 99285
93005 99204 99214 99283 A0427
*The policies and guidelines addressed above are not an all-inclusive listing.
• CPT 94761 will not be separately reimbursed when submitted with the following CPT codes:
99214 99284 99285
• CPT 96110 will not be separately reimbursed when submitted with the following CPT codes:
99391 99392 99393
• CPT 99000 will not be separately reimbursed when submitted with the following CPT codes:
11100 80050 84443 99204 99385 99395
36410 80053 85018 99211 99386 99396
36415 80061 85025 99212 99387 99397
57454 81002 88142 99213 99392
58100 82948 88175 99214 99393
80048 83036 99203 99215 99394
• CPT 99173 will not be separately reimbursed when submitted with the following CPT codes:
99213 99383 99392 99394
99214 99384 99393 99395
• CPT A4209 will not be separately reimbursed when submitted with CPT 99211.
• CPT A4212 will not be separately reimbursed when submitted with the following CPT codes:
96413 99211 99213 99214
• CPT A4215 will not be separately reimbursed when submitted with CPT 36415.
• CPT A4556 will not be separately reimbursed when submitted with CPT E0730.
• CPT Q0091 will not be separately reimbursed when submitted with the following CPT codes:
99385 99386 99395 99396 99397 G0101
• CPT 94664 will not be separately reimbursed when submitted with the following CPT codes:
99213 99214 99244
*The policies and guidelines addressed above are not an all-inclusive listing.
• CPT 97002 will not be separately reimbursed when submitted with the following CPT codes:
97110 97140
• CPT 97140 will not be separately reimbursed when submitted with CPT 98943.
• CPT 99051 will not be separately reimbursed when submitted with the following CPT codes:
99203 99212 99213 99214
• CPT 99053 will not be separately reimbursed when submitted with the following CPT codes:
99282 99283 99284 99285 99291
• CPT 99070 will not be separately reimbursed when submitted with CPT J7050.
• CPT 99215 will not be separately reimbursed when submitted with CPT 99396.
• CPT 99420 will not be separately reimbursed when submitted with CPT 99395.
• CPT 99215 will not be separately reimbursed when submitted with CPT 28190.
• CPT 11101 will not be separately reimbursed when submitted with CPT 17000.
• CPT 36415 will not be separately reimbursed when submitted with the following CPT codes:
80048 82247 82728 83655 84450 85651
80050 82306 82784 83891 84460 85652
80051 82310 82785 84132 84550 86003
80053 82378 82947 84144 84702 86038
80055 82465 82948 84146 84703 86304
80061 82533 82950 84153 85007 86308
80069 82550 82951 84402 85013 86592
80074 82565 82962 84403 85014 86677
80076 82575 83001 84432 85018 86703
82040 82607 83036 84436 85025 86706
82105 82627 83516 84439 85027 86787
82150 82670 83540 84443 85610
*The policies and guidelines addressed above are not an all-inclusive listing.
• CPT 36416 will not be separately reimbursed when submitted with the following CPT codes:
80061 82947 83036 85014 85027
82247 82948 83655 85018 85610
82465 82962 85013 85025
• CPT 36540 will not be separately reimbursed when submitted with the following CPT codes:
80053 85025
• CPT 69210 will not be separately reimbursed when submitted with CPT 99396.
• CPT 71010 will not be separately reimbursed when submitted with the following CPT codes:
99284 99285
• CPT 71020 will not be separately reimbursed when submitted with the following CPT codes:
99284 99285
• CPT 83891 will not be separately reimbursed when submitted with CPT 87491.
• CPT 83901 will not be separately reimbursed when submitted with CPT 87491.
• CPT 90760 will not be separately reimbursed when submitted with CPT 90774.
• CPT 93010 will not be separately reimbursed when submitted with the following CPT codes:
99213 99214 99223 99232 99254 99291
• CPT 93041 will not be separately reimbursed when submitted with CPT A0427.
• CPT 94150 will not be separately reimbursed when submitted with the following CPT codes:
99213 99214
*The policies and guidelines addressed above are not an all-inclusive listing.
• CPT 94760 will not be separately reimbursed when submitted with the following CPT codes:
36415 99203 99204 99213 99214 99215
• CPT 94761 will not be separately reimbursed when submitted with CPT 99214.
• CPT 96110 will not be separately reimbursed when submitted with the following CPT codes:
99391 99392
• CPT 99000 will not be separately reimbursed when submitted with the following CPT codes:
11100 80053 84439 99204 99215 99394
36415 80055 84443 99205 99385 99395
57454 80061 85025 99211 99386 99396
58100 80076 88175 99212 99391
80048 81002 99202 99213 99392
80050 82947 99203 99214 99393
• CPT 99001 will not be separately reimbursed when submitted with the following CPT codes:
36415 80053
• CPT 99144 will not be separately reimbursed when submitted with CPT 77003.
• CPT 99173 will not be separately reimbursed when submitted with the following CPT codes:
99213 99383 99392 99394
99214 99384 99393 99395
• CPT A0999 will not be separately reimbursed when submitted with CPT A0429.
• CPT A4206 will not be separately reimbursed when submitted with CPT 95117.
• CPT A4208 will not be separately reimbursed when submitted with CPT 99211.
*The policies and guidelines addressed above are not an all-inclusive listing.
• CPT A4212 will not be separately reimbursed when submitted with the following CPT codes:
36415 96413 96523 99211 99213 99214
mitted with the following CPT codes:
36415 99211
• CPT A4216 will not be separately reimbursed when submitted with the following CPT codes:
90765 96413 96523 99213 99214 S9501
• CPT A4245 will not be separately reimbursed when submitted with the following CPT codes:
36415 99211
• CPT A4263 will not be separately reimbursed when submitted with CPT 68761.
• CPT A4550 will not be separately reimbursed when submitted with the following CPT codes:
99202 99203 99213 99214
• CPT A4556 will not be separately reimbursed when submitted with CPT E0730.
• CPT A4930 will not be separately reimbursed when submitted with CPT 99211.
• CPT Q0091 will not be separately reimbursed when submitted with the following CPT codes:
99385 99386 99395 99396 G0101
• CPT 76857 will not be separately reimbursed when submitted with CPT 76830.
• CPT 82310 will not be separately reimbursed when submitted with CPT 82330.
*The policies and guidelines addressed above are not an all-inclusive listing.
• CPT 85027 will not be separately reimbursed when submitted with CPT 85025.
• CPT 94260 will not be separately reimbursed when submitted with CPT 94240.
• CPT 94664 will not be separately reimbursed when submitted with the following CPT codes:
99204 99213 99214
• CPT 97002 will not be separately reimbursed when submitted with the following CPT codes:
97110 97112 97530
• CPT 99051 will not be separately reimbursed when submitted with the following CPT codes:
99203 99212 99213 99214
• CPT 99053 will not be separately reimbursed when submitted with the following CPT codes:
99282 99283 99284 99285
• CPT 99070 will not be separately reimbursed when submitted with the following CPT codes:
A4550 J1100
• CPT 99213 will not be separately reimbursed when submitted with CPT 99214.
• CPT A4215 will not be separately reimbursed when submitted with CPT A4550.
• CPT G0101 will not be separately reimbursed when submitted with the following CPT codes:
99214 99395 99396
• CPT 99050 will not be separately reimbursed when submitted with CPT 90772.
*The policies and guidelines addressed above are not an all-inclusive listing.
• CPT 99203 will not be separately reimbursed when submitted with CPT 90772.
• CPT 99204 will not be separately reimbursed when submitted with CPT 90772.
• CPT 99212 will not be separately reimbursed when submitted with CPT 90772.
• CPT 99213 will not be separately reimbursed when submitted with CPT 90772.
• CPT 99214 will not be separately reimbursed when submitted with CPT 90772.
• CPT 99395 will not be separately reimbursed when submitted with CPT 90772.
