tar and non cd6
TAR and Non-Benefit List: Codes 60000 – 699991
BenefitBenefit
CodeDescriptionRestrictionsCodeDescriptionRestrictions
SURGERY (continued)
ENDOCRINE SYSTEM
THYROID GLAND
Incision
60000Incision and drainage of thyroglossal duct cyst, infected3
Excision
60100Biopsy, thyroid, percutaneous needle...... 3
Removal
60300Aspiration and/or injection, thyroid cyst...... 3
PARATHYROID, THYMUS, ADRENAL GLANDS, PANCREAS AND CAROTID BODY
Laparoscopy
60650Laparoscopy, surgical, with adrenalectomy...... 2
60659Unlisted laparoscopy procedure, endocrine system....2
Other Procedures
60699Unlisted procedure, endocrine system...... 2
NERVOUS SYSTEM
SKULL, MENINGES AND BRAIN
Injection, Drainage or Aspiration
61000Subdural tap; initial...... 3
61001Subdural tap; subsequent...... 3
61020Ventricular puncture; without injection...... 3
61026Ventricular puncture; with injection...... 3
61050Cisternal or lateral cervical puncture; without injection..3
61055Cisternal or lateral cervical puncture; with injection....3
61070Puncture of shunt tubing for aspiration or injection....3
Twist Drill, Burr Hole(s) or Trephine
61105Twist drill hole for subdural or ventricular puncture....3
61107Twist drill hole(s) for subdural, intracerebral, or ventricular puncture; for implanting ventricular catheter, pressure recording device, or other intracerebral monitoring device 3
61108Twist drill hole for puncture; evacuate hematoma.....3
61151Burr hole(s) or trephine; subsequent tapping of abscess/cyst3
Endovascular Therapy
61645Percutaneous arterial transluminal mechanical thrombectomy and/or infusion for thrombolysis, intracranial3
61650Endovascular intracranial prolonged administration of pharmacologic agent(s) other than for thrombolysis, aterial; initial vascular territory 3
61651Endovascular intracranial prolonged administration of pharmacologic agent(s) other than for thrombolysis, aterial; each additional vascular territory 3
SURGERY OF SKULL BASE
Neurostimulators (Intracranial)
61850Burr holes, implantation neurostimulator electrodes; cortical1
61860Craniectomy or craniotomy for implantation of neurostimulator electrodes; cortical1
61863Twist drill, burr hole, craniotomy, or craniotomy with stereotactic implantation of neurostimulator electrode array in subcortical site; first array 1
61864Twist drill, burr hole, craniotomy, or craniotomy with stereotactic implantation of neurostimulator electrode array in subcortical site; each additional array 1
61867Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implementation of neurostimulator electrode array in subcortical site, with use of intraoperative microelectrode recording; first array 2
61868Twist drill, burr hole, craniotomy, or craniectomy with stereotactic implementation of neurostimulator electrode array in subcortical site, with use of intraoperative microelectrode recording; each additional array 2
61870Craniectomy, implantation neurostimulator electrodes; cortical1
61880Revision/removal intracranial neurostimulator electrodes2
61886Insertion or replacement of cranial neurostimulator pulse generator or receiver; with connection to two or more electrode arrays 3
61888Revision or removal/cranial neurostimulator...... 2
Cerebrospinal Fluid (CSF) Shunt
62252Reprogramming of programmable cerebrospinal shunt.3
Benefit Restriction Descriptions:1Non-Benefit3Assistant Surgeon services not payable
2Requires TAR,
Primary Surgeon/Provider
2 – TAR and Non-Benefit List: Codes 60000 – 69999
September 2016
tar and non cd6
1
BenefitBenefit
CodeDescriptionRestrictionsCodeDescriptionRestrictions
SPINE AND SPINAL CORD
Injection, Drainage or Aspiration
62263Percutaneous lysis of epidural adhesions, multiple adhesiolysis sessions; two or more days3
62264Percutaneous lysis of epidural adhesions, multiple adhesiolysis sessions; one day3
62267Percutaneous aspiration within the nucleus pulposus..3
62268Percutaneous aspiration, spinal cord cyst or syrinx....3
62269Biopsy of spinal cord, percutaneous needle...... 3
62270Spinal puncture, lumbar, diagnostic...... 3
62272Spinal puncture, therapeutic, for drainage of cerebrospinal fluid3
62273Injection, epidural, of blood or clot patch...... 3
62280Injection/infusion of neurolytic substance; subarachnoid3
62281Injection of neurolytic substance; epidural, cervical, thoracic3
62282Injection/infusion of neurolytic substance; epidural, lumbar, sacral (caudal)3
62284Injection procedure for myelography and/or computed tomography, lumbar (other than C1-C2 and posterior fossa)3
62287Decompression procedure, percutaneous, of nucleus pulposus of intervertebral disc, any method utilizing needle based technique to remove disc material under fluoroscopic imaging or other indirect visualization 3
62292Injection procedure for chemonucleolysis,including discography, intervertebral disc, single or multiple levels, lumbar 3
62302Myelography via lumbar injection, including radiological supervision and interpretation; cervical3
62303Myelography via lumbar injection, including radiological supervision and interpretation; thoracic3
62304Myelography via lumbar injection, including radiological supervision and interpretation; lumbosacral3
62305Myelography via lumbar injection, including radiological supervision and interpretation; two or more regions3
62320Injection(s), of diagnostic or therapeutic substance(s), cervical or thoracic; without imaging guidance3
62321Injection(s), of diagnostic or therapeutic substance(s), cervical or thoracic; with imaging guidance3
62322Injection(s), of diagnostic or therapeutic substance(s), lumbar or sacral (caudal); without imaging guidance3
62323Injection(s), of diagnostic or therapeutic substance(s), lumbar or sacral (caudal); with imaging guidance3
62324Injection(s), including indwelling catheter placement, cervical or thoracic; without imaging guidance3
62325Injection(s), including indwelling catheter placement, cervical or thoracic; with imaging guidance3
62326Injection(s), including indwelling catheter placement, lumbar or sacral (caudal); without imaging guidance3
Injection, Drainage or Aspiration (continued)
62327Injection(s), including indwelling catheter placement, lumbar or sacral (caudal); with imaging guidance3
Reservoir/Pump Implantation
62367Electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion; without reprogramming3
62368Electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion; with reprogramming3
62369Electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion; with reprogramming and refill 3
62370Electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion; with reprogramming and refill (requiring physician’s skill) 3
Neurostimulators (Spinal)
63650Percutaneous implantation of neurostimulator electrode array, epidural2
63655Laminectomy for implantation of neurostimulator electrodes, plate/paddle, epidural2
63685Insertion or replacement of spinal neurostimulator pulse generator/receiver2
EXTRACRANIAL NERVES, PERIPHERAL NERVES, AND AUTONOMIC NERVOUS SYSTEM
INTRODUCTION/INJECTION OF ANESTHETIC AGENT (NERVE BLOCK), DIAGNOSTIC OR THERAPEUTIC
Somatic Nerves
64400Injection, anesthetic agent; trigeminal nerve...... 3
64402Injection, anesthetic agent; facial nerve...... 3
64405Injection, anesthetic agent; greater occipital nerve....3
64408Injection, anesthetic agent; vagus nerve...... 3
64410Injection, anesthetic agent; phrenic nerve...... 3
64413Injection, anesthetic agent; cervical plexus...... 3
64415Injection, anesthetic agent; brachial plexus, single....3
64416Injection, anesthetic agent; brachial plexus, continuous infusion by catheter3
64417Injection, anesthetic agent; axillary nerve...... 3
64418Injection, anesthetic agent; suprascapular nerve...... 3
Benefit Restriction Descriptions:1Non-Benefit3Assistant Surgeon services not payable
2Requires TAR,
Primary Surgeon/Provider
2 – TAR and Non-Benefit List: Codes 60000 – 69999
January 2018
tar and non cd6
1
BenefitBenefit
CodeDescriptionRestrictionsCodeDescriptionRestrictions
INTRODUCTION/INJECTION OF ANESTHETIC AGENT (NERVE BLOCK), DIAGNOSTIC OR THERAPEUTIC(continued)
Somatic Nerves(continued)
64420Injection, anesthetic agent; intercostal nerve, single...3
64421Injection, anesthetic agent; intercostal nerves, multiple, regional block3
64425Injection, anesthetic agent; ilioinguinal, iliohypogastric nerves3
64430Injection, anesthetic agent; pudendal nerve...... 3
64435Injection, anesthetic agent; paracervical nerve...... 3
64445Injection, anesthetic agent; sciatic nerve, single...... 3
64446Injection, anesthetic agent; sciatic nerve, continuous infusion by catheter3
64447Injection, anesthetic agent; femoral nerve, single.....3
64448Injection, anesthetic agent; femoral nerve, continuous infusion by catheter3
64449Injection, anesthetic agent; lumbar plexus, posterior approach, continuous infusion by catheter3
64450Injection, anesthetic agent; other peripheral nerve....3
64455Injection(s), anesthetic agent and/or steroid, plantar common digital3
64461Paravertebral block, thoracic; single injection site.....3
64462Paravertebral block, thoracic; second and any additional injection site(s)3
64463Paravertebral block, thoracic; continuous infusion by catheter3
64479Injection, anesthetic agent and/or steroid, transforaminal epidural; cervical or thoracic, single level3
64480Injection, anesthetic agent and/or steroid, transforaminal epidural; cervical or thoracic, each additional level3
64483Injection, anesthetic agent and/or steroid, transforaminal epidural; lumbar or sacral, single level3
64484Injection, anesthetic agent and/or steroid, transforaminal epidural; lumbar or sacral, each additional level3
64486Transversus abdominis plane block unilateral; by injection(s)3
64487Transversus abdominis plane block unilateral; by continuous infusion(s)3
64488Transversus abdominis plane block bilateral; by injection(s)3
64489Transversus abdominis plane block bilateral; by continuous infusion(s)3
64490Injection, diagnostic or therapeutic agent, paravertebral facet joint with image guidance, cervical or thoracic; single level3
Somatic Nerves (continued)
64491Injection, diagnostic or therapeutic agent, paravertebral facet joint with image guidance, cervical or thoracic; second level3
64492Injection, diagnostic or therapeutic agent, paravertebral facet joint with image guidance, cervical or thoracic; third and any additional levels 3
64493Injection, diagnostic or therapeutic agent, paravertebral facet joint with image guidance, lumbar or sacral; single level3
64494Injection, diagnostic or therapeutic agent, paravertebral facet joint with image guidance, lumbar or sacral; second level3
64495Injection, diagnostic or therapeutic agent, paravertebral facet joint with image guidance, lumbar or sacral; third and any additional levels 3
Autonomic Nerves
64505Injection, anesthetic agent; sphenopalatine ganglion...3
64510Injection, anesthetic agent; stellate ganglion...... 3
64517Injection, anesthetic agent; superior hypogastric plexus3
64520Injection, anesthetic agent; lumbar or thoracic...... 3
64530Injection, anesthetic agent; celiac plexus...... 3
Benefit Restriction Descriptions:1Non-Benefit3Assistant Surgeon services not payable
2Requires TAR,
Primary Surgeon/Provider
2 – TAR and Non-Benefit List: Codes 60000 – 69999
December 2018
tar and non cd6
1
BenefitBenefit
CodeDescriptionRestrictionsCodeDescriptionRestrictions
Neurostimulators (Peripheral Nerve)
64553Percutaneous implantation of neurostimulator electrodes; cranial nerve2
64555Percutaneous implantation of neurostimulator electrodes; peripheral nerve1
64561Percutaneous implantation of neurostimulator electrodes; sacral nerve1
64566Posterior tibial neurostimulation percutaneous needle electrode, single treatment, includes programming3
64568 Incision for implantation of cranial nerve neurostimulator electrode array and pulse generator 2
64575Incision for implantation of neurostimulator electrodes; peripheral nerve (excludes sacral nerve)3
64580Incision for implantation of neurostimulator electrodes; neuromuscular1
64581Incision for implantation of neurostimulator electrodes; sacral nerve1
64585Revision/removal of peripheral neurostimulator electrode array3
64590Insertion or replacement of peripheral neurostimulator generator or receiver3
64595Revision/removal peripheral neurostimulator generator or receiver3
Destruction by Neurolytic Agent, CHEMODENERVATION
Somatic Nerves
64600Destruction by neurolytic agent, trigeminal nerve; supraorbital, infraorbital, mental, or inferior alveolar branch3
64605Destruction by neurolytic agent, trigeminal nerve; second and third division branches at foramen ovale3
64610Destruction by neurolytic agent, trigeminal nerve; second and third division branches at foramen ovale under radiologic monitoring 3
64611Chemodenervation of parotid and submandibular salivary glands3
64612Chemodenervation of muscles(s); muscles innervated by facial nerve3
64615Chemodenervation of muscle(s); muscle(s) innervated by facial, trigeminal, cervical spinal and accessory nerves, bilateral3
64616Chemodenervation of muscle(s); neck muscle(s), excluding muscles of the larynx, unilateral3
64617Chemodenervation of muscle(s); larynx, unilateral, percutaneous3
Somatic Nerves (continued)
64620Destruction by neurolytic agent; intercostal nerve.....3
64630Destruction by neurolytic agent; pudendal nerve...... 3
64632Destruction by neurolytic agent; plantar common digital3
64633Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, single facet joint 3
64634Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, each additional facet joint 3
64635Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, single facet joint 3
64636Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, each additional facet joint 3
64640Destruction by neurolytic agent; other peripheral nerve/branch3
64642Chemodenervation of one extremity; 1-4 muscle(s)....3
64643Chemodenervation of one extremity; each additional extremity, 1-4 muscle(s)3
64644Chemodenervation of one extremity; 5 or more muscles3
64645Chemodenervation of one extremity; each additional extremity, 5 or more muscles3
64646Chemodenervation of trunk muscle(s); 1-5 muscle(s)..3
64647Chemodenervation of one extremity; 5 or more muscles 6 or more muscles.3
Sympathetic Nerves
64650Chemodenervation of eccrine glands; both axillae...2, 3
64653Chemodenervation of other areas
(scalp, face, neck), per day...... 2, 3
64680Destruction by neurolytic agent; celiac plexus...... 3
64681Destruction by neurolytic agent; superior hypogastric plexus3
Benefit Restriction Descriptions:1Non-Benefit3Assistant Surgeon services not payable
2Requires TAR,
Primary Surgeon/Provider
2 – TAR and Non-Benefit List: Codes 60000 – 69999
December 2018
tar and non cd6
1
BenefitBenefit
CodeDescriptionRestrictionsCodeDescriptionRestrictions
Destruction by Neurolytic Agent, CHEMODENERVATION (continued)
Neuroplasty (Exploration, Neurolysis or Nerve Decompression)
64721Neuroplasty/transposition; median nerve at carpal tunnel 2
Other Procedures
64999Unlisted procedure, nervous system...... 2
EYE AND OCULAR ADNEXA
EYEBALL
Secondary Implant(s) Procedures
65125Modification of ocular implant...... 3
Removal of Foreign Body
65205Removal of foreign body, external eye; conjunctival...3
65210Removal of foreign body, external eye; subconjunctival.3
65220Removal of foreign body, external eye; corneal...... 3
65222Removal of foreign body, external eye; corneal, slit lamp3
ANTERIOR SEGMENT
CORNEA
Excision
65400Excision of lesion, cornea...... 3
65410Biopsy of cornea...... 3
65420Excision or transposition of pterygium...... 3
Removal or Destruction
65450Destruction of lesion of cornea...... 3
Other Procedures
65760Keratomileusis...... 1
65765Keratophakia...... 1
65767Epikeratoplasty...... 1
65770Keratoprosthesis...... 2
65771Radial keratotomy...... 1
65772Corneal relaxing incision...... 1
65775Corneal wedge resection...... 1
65785Implantation of intrastromal corneal ring segments..2, 3
ANTERIOR CHAMBER
Incision
65800Paracentesis of anterior chamber; removal of aqueous.3
65810Paracentesis of anterior chamber; removal vitreous...3
Introduction
66020Injection, anterior chamber of eye; air or liquid...... 3
66030Injection, anterior chamber of eye; medication...... 3
ANTERIOR SCLERA
Excision
66174Transluminal dilation of aqueous outflow canal; without retention of device or stent1
66175Transluminal dilation of aqueous outflow canal; with retention of device or stent1
Aqueous Shunt
66183Insertion of anterior segment aqueous drainage device, without extraocular reservoir, external approach1
IRIS, CILIARY BODY
Destruction
66761Iridotomy/iridectomy by laser surgery...... 3
66762Iridoplasty by photocoagulation...... 3
LENS
Removal
66830Removal of secondary membranous cataract...... 2
66840Removal of lens material; aspiration technique...... 2
66850Removal lens material; phacofragmentation technique.2
66852Removal of lens material; pars plana approach...... 2
66920Removal of lens material; intracapsular...... 2
66930Removal of lens material; intracapsular, dislocated lens2
66940Removal of lens material; extracapsular...... 2
Intraocular Lens Procedures
66982Extracapsular cataract removal with insertion of intraocular lens prosthesis, complex2
66983Intracapsular cataract extraction with insertion of intraocular lens prosthesis2
66984Extracapsular cataract removal with insertion intraocular lens prosthesis2
66985Insertion of intraocular lens prosthesis, not associated with concurrent cataract removal2
Other Procedures
66990Use of ophthalmic endoscope...... 3
66999Unlisted procedure, anterior segment of eye...... 2
POSTERIOR SEGMENT
Retina or Choroid
Repair
67101Repair of retinal detachment; cryotherapy...... 3
67105Repair of retinal detachment; photocoagulation...... 3
Other Procedures
67299Unlisted procedure, posterior segment...... 2
Benefit Restriction Descriptions:1Non-Benefit3Assistant Surgeon services not payable
2Requires TAR,
Primary Surgeon/Provider
2 – TAR and Non-Benefit List: Codes 60000 – 69999
September 2017
tar and non cd6
1
BenefitBenefit
CodeDescriptionRestrictionsCodeDescriptionRestrictions
Ocular Adnexa
Extraocular Muscles
67311Strabismus surgery, recession or resection procedure; one horizontal muscle2
67312Strabismus surgery; two horizontal muscles...... 2
67314Strabismus surgery; one vertical muscle...... 2
67316Strabismus surgery; two or more vertical muscles.....2
67318Strabismus surgery, any procedure, superior oblique muscle2
67320Transposition procedure, any extraocular muscle.....2
67331Strabismus surgery on patient with previous eye surgery or injury that did not involve the extraocular muscles2
67332Strabismus surgery on patient with scarring of extraocular muscles or restrictive myopathy2
67334Strabismus surgery by posterior fixation suture technique, with or without muscle recession2
67340Strabismus surgery involving exploration and/or repair of detached extraocular muscle(s)2
67343Release of extensive scar tissue without detaching extraocular muscle2
67345Chemodenervation of extraocular muscle...... 3
Other Procedures
67399Unlisted procedure, ocular muscle...... 2
ORBIT
Exploration, Excision, Decompression
67415Fine needle aspiration of orbital contents...... 3
Other Procedures
67500Retrobulbar injection; medication...... 3
67505Retrobulbar injection; alcohol...... 3
67515Injection of medication or other substance into Tenon's capsule3
67599Unlisted procedure, orbit...... 2
EYELIDS
Incision
67700Blepharotomy, drainage of abscess, eyelid...... 3
67710Severing of tarsorrhaphy...... 3
67715Canthotomy...... 3
Excision, Destruction
67800Excision of chalazion; single...... 3
67801Excision of chalazion; multiple...... 3
67805Excision of chalazion; multiple, different lids...... 3
67810Biopsy of eyelid...... 3
67820Correction of trichiasis; epilation, by forceps only.....3
67825Correction of trichiasis; epilation, by other than forceps.3
67840Excision of lesion of eyelids...... 3
67850Destruction of lesion of lid margin...... 3
Repair (Brow Ptosis, Blepharoptosis, Lid Retraction, Ectropion, Entropion)
67901Repair of blepharoptosis; frontalis muscle technique with suture or other material2
67902Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling2
Repair (Brow Ptosis, Blepharoptosis, Lid Retraction, Ectropion, Entropion) (continued)
67903Repair of blepharoptosis; levator resection/advancement, internal2
67904Repair of blepharoptosis; levator resection/advancement, external2
67906Repair of blepharoptosis; superior rectus technique, fascial sling2
67908Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection2
67909Reduction of overcorrection of ptosis...... 2
67911Correction of lid retraction...... 2
67912Correction of lagophthalmos, with implantation of upper eyelid load2
67914Repair of ectropion; suture...... 2, 3
67915Repair of ectropion; thermocauterization...... 2, 3
67916Repair of ectropion; excision tarsal wedge...... 2
67917Repair of ectropion; extensive...... 2
67921Repair of entropion; suture...... 2, 3
67922Repair of entropion; thermocauterization...... 2, 3
67923Repair of entropion; excision tarsal wedge...... 2
67924Repair of entropion; extensive...... 2
Reconstruction
67930Suture recent wound, eyelid; partial thickness...... 3
67950Canthoplasty...... 2
67961Excision and repair, eyelid; up to one-fourth of lid margin 2
67966Excision and repair, eyelid; over one-fourth of lid margin2
67971Reconstruction, eyelid; up to two-thirds of eyelid...... 2
67973Reconstruction, eyelid; total eyelid, lower...... 2
67974Reconstruction, eyelid; total eyelid, upper...... 2
67975Reconstruction, eyelid; second stage...... 2
Other Procedures
67999Unlisted procedure, eyelids...... 2
CONJUNCTIVA
Incision and Drainage
68020Incision of conjunctiva, drainage cyst...... 3
68040Expression of conjunctival follicles...... 3
Excision and/or Destruction
68100Biopsy of conjunctiva...... 3
68110Excision of lesion, conjunctiva; up to 1 cm...... 3
68135Destruction of lesion, conjunctiva...... 3
Injection
68200Subconjunctival injection...... 3
Other Procedures
68399Unlisted procedure, conjunctiva...... 2
LACRIMAL SYSTEM
Incision
68440Snip incision of lacrimal punctum...... 3
Benefit Restriction Descriptions:1Non-Benefit3Assistant Surgeon services not payable
2Requires TAR,
Primary Surgeon/Provider
2 – TAR and Non-Benefit List: Codes 60000 – 69999
September 2016
tar and non cd6
1
BenefitBenefit
CodeDescriptionRestrictionsCodeDescriptionRestrictions
LACRIMAL SYSTEM (continued)
Repair
68700Plastic repair of canaliculi...... 2
68705Correction of everted punctum, cautery...... 3
68760Closure of lacrimal punctum...... 3
68761Closure of lacrimal punctum; by plug, each...... 3
Probing and/or Related Procedures
68801Dilation of lacrimal punctum...... 3
68810Probing of nasolacrimal duct...... 3
68840Probing of lacrimal canaliculi...... 3
68850Injection of contrast medium for dacryocystography...3
Other Procedures
68899Unlisted procedure, lacrimal system...... 2
AUDITORY SYSTEM
EXTERNAL EAR
Incision
69000Drainage external ear; simple...... 3
69020Drainage external auditory canal, abscess...... 3
69090Ear piercing...... 1
Excision
69100Biopsy external ear...... 3
69105Biopsy external auditory canal...... 3
69110Excision external ear; partial...... 3
Removal
69200Removal foreign body, external ear canal; without anesthesia3
69205Removal foreign body, external ear canal; with anesthesia3
69209Removal impacted cerumen using irrigation/lavage, unilateral3
69210Removal impacted cerumen, requiring instrumentation, unilateral3
69220Debridement, mastoidectomy cavity, simple...... 3
69222Debridement, mastoidectomy cavity, complex...... 3
Repair
69300Otoplasty, protruding ear...... 2
Other Procedures
69399Unlisted procedure, external ear...... 2
MIDDLE EAR
Incision
69420Myringotomy...... 3
69421Myringotomy, requiring general anesthesia...... 1
69424Ventilating tube removal requiring general anesthesia..3
69433Tympanostomy, local or topical anesthesia...... 3
69436Tympanostomy, general anesthesia...... 3
Repair
69610Tympanic membrane repair...... 3
Other Procedures
69710Implantation bone conduction device, temporal bone..1
69711Removal/repair bone conduction device, temporal bone1
69714Implantation; without mastoidectomy...... 1
69715Implantation; with mastoidectomy...... 1
69717Replacement of implant; without mastoidectomy...... 1
69718Replacement of implant; with mastoidectomy...... 1
69799Unlisted procedure, middle ear...... 2
INNER EAR
Introduction
69930Cochlear device implantation...... 2
Other Procedures
69949Unlisted procedure, inner ear...... 2
TEMPORAL BONE, MIDDLE FOSSA APPROACH
Other Procedures
69979Unlisted procedure, temporal bone...... 2
Benefit Restriction Descriptions:1Non-Benefit3Assistant Surgeon services not payable
2Requires TAR,
Primary Surgeon/Provider
2 – TAR and Non-Benefit List: Codes 60000 – 69999
September 2016