Active Medical Reviews: October 2024 to September 2025
Published 10/16/2024
Active Medical Reviews: October 2024 Through September 2025
| Service Type | CPT®/HCPCS Code | Code Description | Review Type |
|---|---|---|---|
| Ambulance | A0425 | BLS/ALS mileage, per statue mile (in combination with transport codes) | TPE, pre-payment, postpayment |
| Ambulance | A0427 | ALS1, emergency | TPE, pre-payment, postpayment |
| Ambulance | A0429 | BLS, emergency | TPE, pre-payment, postpayment |
| Ambulance | A0431 | Rotary wing air transport | TPE, pre-payment, postpayment |
| Ambulance |
A0436 |
Rotary wing air mileage, per statute mile (in combination with air transport code) | TPE pre-payment, postpayment |
| Drugs/Biologics | J0178 | Aflibercept injection | TPE |
| Drugs/Biologics | J0897 | Denosumab Injection | TPE |
| Drugs/Biologics | J2778 | Ranibizumab injection | TPE |
| Echocardiography | 93306 | Echocardiography, transthoracic, real-time with image documentation | Pre-payment |
| Evaluation and Management | 99213 | Office/outpatient visit, established (usually 20–29 minutes time) | TPE |
| Evaluation and Management | 99214 | Office/outpatient visit, established (usually 30–39 minutes time) | TPE |
| Evaluation and Management | 99215 | Office/outpatient visit, established (usually 40–54 minutes time) |
TPE |
| Evaluation and Management | 99222 | Initial hospital care | TPE |
| Evaluation and Management | 99223 | Initial hospital care | TPE |
| Evaluation and Management | 99232 | Subsequent hospital care | TPE |
| Laboratory | G0480 | Drug test definitive 1–7 classes | Postpayment |
| Laboratory | G0481 | Drug test, definitive, 8–14 classes | Postpayment |
| Laboratory | G0482 | Drug test, definitive, 15–21 classes | Postpayment |
| Laboratory | G0483 | Drug test, definitive, 22 or more classes | Postpayment |
| Laboratory | 80305 | Drug test, presumptive; direct optical observation | Postpayment |
| Laboratory | 80306 | Drug test, presumptive; instrument-assisted | Postpayment |
| Laboratory | 80307 | Drug test, presumptive; chemistry analyzers | Postpayment |
| Laboratory | 88305 | Tissue exam by pathologist | Postpayment |
| Laboratory | 88307 | Tissue exam by pathologist | Postpayment |
| Laboratory | 88309 | Tissue exam by pathologist | Postpayment |
| Laboratory | 88312 | Special stains; group 1 | Postpayment |
| Radiology | 71045 | X-ray exam chest 1 view | TPE, pre-payment, postpayment |
| Radiology | 71046 | X-ray exam chest 2 views | TPE, pre-payment, postpayment |
| Radiology | 71260 | Diagnostic imaging procedures of the chest | Pre-payment |
| Radiology | 77080 | DXA, bone density axial | TPE, pre-payment, postpayment |
| Radiology | R0070 | Transport portable X-ray | TPE, postpayment |
| Radiology | R0075 | Transport portable X-ray multiple | TPE, postpayment |
| Radiology | Q0092 | Set-up portable X-ray equipment | TPE, postpayment |
| Surgical Services | 66984 | Extracapsular cataract removal with insertion | Pre-payment |
| Therapeutic Procedures | 97110 | Therapeutic exercises | Pre-payment |
| Therapeutic Procedures | 97112 | Neuromuscular reeducation | Pre-payment |
| Therapeutic Procedures | 97113 | Aquatic therapy/exercises | Pre-payment |
| Therapeutic Procedures | 97116 | Gait training therapy | Pre-payment |
| Therapeutic Procedures | 97140 | Manual therapy, 1/> regions | Pre-payment |
| Therapeutic Procedures | 97150 | Group therapeutic procedures | Pre-payment |
CPT® codes and modifiers begin with a numeric character and HCPCS codes and modifiers begin with an alpha character. CPT® codes, descriptors and other data only are copyright ® 2023 American Medical Association. All rights reserved.
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