2024 CPT® Updates (Professional Services Focused) - Part 3

© Health Catalyst. Confidential and Proprietary.
2024 CPT® Updates – Professional Focus
Ardith Campbell, COC, CPC

Disclaimer Statement
This webinar/presentation was current at the time it was published or provided
via the web and is designed to provide accurate and authoritative information
regarding the subject matter covered. The information provided is only
intended to be a general overview with the understanding that neither the
presenter nor the event sponsor is engaged in rendering specific coding advice.
It is not intended to take the place of either the written policies or regulations.
We encourage participants to review the specific regulations and other
interpretive materials, as necessary.

Agenda
• Review of Overall Changes
• Chapter Review of Code Updates
• Category III Changes Included with CPT® Section
• Review of Major Guideline Updates

Overview of Updates

Current Procedural Terminology (CPT®) Updates
Section Added Deleted Revised
Evaluation and Management 1 0 10
Anesthesia 0 0 0
Surgery 23 0 10
Radiology 5 1 0
Path/Lab 13 0 16
Medicine 21 0 4
Category II 0 0 0
Category III 63 32 13
MAAA 0 1 0
PLA Codes 19 0 2
TOTALS 145 34 55

Evaluation and
Management (E/M)

Evaluation and Management (E/M)
• 99459 Pelvic Examination (List separately in addition to code for primary procedure)
• CPT Parenthetical note
• (Use 99459 in conjunction with 99202, 99203, 99204, 99205, 99212, 99213, 99214,
99215, 99242, 99243, 99244, 99245, 99383, 99384, 99385, 99386, 99387, 99393, 99394,
99395, 99396, 99397)
• Practice Expense (PE) Relative Value Unit (RVU) 0.68
• No change to the Preventive Services Benefit
• G0101 Cervical or vaginal cancer screening; pelvic and clinical breast examination
• Q0091 Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or
vaginal smear to laboratory
• Waives deductible and coinsurance

Split or Shared Visit
• Time
• Visit reported by the one who spent the majority of time performing the service
• Include face-to-face time
• Include non-face-to-face time
• Medical Decision Making (MDM)
• The one who made or approved the management plan for the number and complexity of
problems addressed at the encounter
and
• Takes responsibility for that plan and the inherent risk of complications and/or morbidity or
mortality of patient management
• Modifier FS Split (or shared) evaluation and management visit

Split or Shared Visits
Physician(s) and other qualified health care professional(s) (QHP[s]) may act as a
team in providing care for the patient, working together during a single E/M service.
The split or shared visits guidelines are applied to determine which professional may
report the service. If the physician or other QHP performs a substantive portion of
the encounter, the physician or other QHP may report the service. If code selection
is based on total time on the date of the encounter, the service is reported by the
professional who spent the majority of the face-to-face or non-face-to-face time
performing the service. For the purpose of reporting E/M services within the
context of team-based care, performance of a substantive part of the MDM requires
that the physician(s) or other QHP(s) made or approved the management plan for
the number and complexity of problems addressed at the encounter and takes
responsibility for that plan with its inherent risk of complications and/or morbidity
or mortality of patient management.

Split or Shared Visits, continued
By doing so, a physician or other QHP has performed two of the three
elements used in the selection of the code level based on MDM. If the
amount and/or complexity of data to be reviewed and analyzed is
used by the physician or other QHP to determine the reported code
level, assessing an independent historian’s narrative and the ordering or
review of tests or documents do not have to be personally performed
by the physician or other QHP, because the relevant items would be
considered in formulating the management plan. Independent
interpretation of tests and discussion of management plan or test
interpretation must be personally performed by the physician or other
QHP if these are used to determine the reported code level by the
physician or other QHP.

Levels of Medical Decision Making (MDM)
The term “risk” as used in the definition of
this element relates to risk from the
condition. While condition risk and
management risk may often correlate, the
risk from the condition is distinct from the
risk of the management.
Parenteral controlled substances: The level
of risk is based on the usual behavior and
thought processes of a physician or other
qualified health care professional in the
same specialty and subspecialty and not
simply based on the presence of an order
for parenteral controlled substances.

99202
Office or other outpatient visit for the
evaluation and management of a new
patient, which requires a medically
appropriate history and/or examination
and straightforward medical decision
making. When using time for code
selection, 15-29 minutes of total time is
spent on the date of the encounter.
and straightforward medical decision
making. When using total time on the
date of the encounter for code selection,
15 minutes must be met or exceeded.
2024 versus 2023

99203
and low level of medical decision making.
When using time for code selection, 30-
44 minutes of total time is spent on the
date of the encounter.
and low level of medical decision making.
When using total time on the date of the
encounter for code selection, 30 minutes
must be met or exceeded.
2024 versus 2023

99204
and moderate level of medical decision
and moderate level of medical decision
2024 versus 2023

99205
and high level of medical decision
and high level of medical decision
2024 versus 2023

99212
evaluation and management of an
established patient, which requires a
medically appropriate history and/or
examination and straightforward medical
decision making. When using time for
code selection, 10-19 minutes of total
time is spent on the date of the
encounter.
examination and straightforward medical
decision making. When using total time
on the date of the encounter for code
selection, 10 minutes must be met or
exceeded.
2024 versus 2023

99213
examination and low level of medical
encounter.
examination and low level of medical
decision making. When using total time
on the date of the encounter for code
selection, 20 minutes must be met or
exceeded.
2024 versus 2023

99214
examination and moderate level of
medical decision making. When using
time for code selection, 30-39 minutes of
total time is spent on the date of the
encounter.
examination and moderate level of
medical decision making. When using
total time on the date of the encounter
for code selection, 30 minutes must be
met or exceeded.
2024 versus 2023

99215
Office or other outpatient visit for the evaluation and management of an established
patient, which requires a medically appropriate history and/or examination and high level of
medical decision making. When using total time on the date of the encounter for code
selection, 40 minutes must be met or exceeded.
examination and high level of medical
encounter.
2024 versus 2023

99306
Initial nursing facility care, per day, for
the evaluation and management of a
appropriate history and/or
decision making. When using total
time on the date of the encounter for
code selection, 45 minutes must be
met or exceeded.
Initial nursing facility care, per day, for
the evaluation and management of a
appropriate history and/or
decision making. When using total
time on the date of the encounter for
code selection, 50 minutes must be
met or exceeded.
2024 versus 2023

99308
Subsequent nursing facility care, per
day, for the evaluation and
management of a patient, which
requires a medically appropriate
history and/or examination and low
level of medical decision making.
When using total time on the date of
the encounter for code selection, 15
minutes must be met or exceeded.
Subsequent nursing facility care, per
day, for the evaluation and
management of a patient, which
requires a medically appropriate
history and/or examination and low
level of medical decision making.
When using total time on the date of
the encounter for code selection, 20
minutes must be met or exceeded.
2024 versus 2023

Multiple E/M Services on the Same Date
The following guidelines apply to services that a patient may receive for hospital inpatient
care, observation care, or nursing facility care. For instructions regarding transitions to these
settings from the office or outpatient, home or residence, or emergency department
setting, see guidelines for Hospital Inpatient and Observation Care Services or Nursing
Facility Services.
A patient may receive E/M services in more than one setting on a calendar date. A patient
may also have more than one visit in the same setting on a calendar date. The guidelines for
multiple E/M services on the same date address circumstances in which the patient has
received multiple visits or services from the same physician or other QHP or another
physician or other QHP of the exact same specialty and subspecialty who belongs to the
same group practice.

Per day: The hospital inpatient and observation care services and the
nursing facility services are “per day” services. When multiple visits
occur over the course of a single calendar date in the same setting, a
single service is reported. When using MDM for code level selection,
use the aggregated MDM over the course of the calendar date. When
using time for code level selection, sum the time over the course of the
day using the guidelines for reporting time.

Multiple encounters in different settings or facilities: A patient may be seen and treated in
different facilities (eg, a hospital-to-hospital transfer). When more than one primary E/M
service is reported and time is used to select the code level for either service, only the time
spent providing that individual service may be allocated to the code level selected for
reporting that service. No time may be counted twice when reporting more than one E/M
service. Prolonged services are also based on the same allocation and their relationship to
the primary service. The designation of the facility may be defined by licensure or
regulation. Transfer from a hospital bed to a nursing facility bed in a hospital with nursing
facility beds is considered as two services in two facilities because there is a discharge from
one type of designation to another. An intra-facility transfer for a different level of care
(eg, from a routine unit to a critical care unit) does not constitute a new stay, nor does it
constitute a transfer to a different facility.

Emergency department (ED) and
services in other settings (same or
different facilities): Time spent in an ED
by a physician or other QHP who
provides subsequent E/M services may
be included in calculating total time on
the date of the encounter when ED
services are not reported and another
E/M service is reported (eg, hospital
inpatient and observation care services).

Discharge services and services in other facilities: Each service may be reported
separately as long as any time spent on the discharge service is not counted towards
the total time of a subsequent service in which code level selection for the
subsequent service is based on time. This includes any hospital inpatient or
observation care services (including admission and discharge services) time (99234,
99235, 99236) because these services may be selected based on MDM or time.
When these services are reported with another E/M service on the same calendar
date, time related to the hospital inpatient or observation care service (including
admission and discharge services) may not be used for code selection of the
subsequent service.

Discharge services and services in the same facility: If the patient is discharged and
readmitted to the same facility on the same calendar date, report a subsequent care service
instead of a discharge or initial service. For the purpose of E/M reporting, this is a single
stay.
Discharge services and services in a different facility: If the patient is admitted to another
facility, for the purpose of E/M reporting this is considered a different stay. Discharge and
initial services may be reported as long as time spent on the discharge service is not
counted towards the total time of the subsequent service reported when code level
selection is based on time.
Critical care services (including neonatal intensive care services and pediatric and
neonatal critical care): Reporting guidelines for intensive and critical care services that are
performed on the same calendar date as another E/M service are described in the service
specific section guidelines.

Transitions between office or other outpatient, home or residence, or emergency
department and hospital inpatient or observation or nursing facility: See the
guidelines for Hospital Inpatient and Observation Care Services or Nursing Facility
Services. If the patient is seen in two settings and only one service is reported, the
total time on the date of the encounter or the aggregated MDM is used for
determining the level of the single reported service. If prolonged services are
reported, use the prolonged services code that is appropriate for the primary
service reported, regardless of where the patient was located when the prolonged
services time threshold was met. The choice of the primary service is at the
discretion of the reporting physician or other QHP.

Scenario 1 – Two Providers, Two Settings
Q. I see a Medicare patient in the office,
and after evaluation, determine the patient
requires hospitalization. My practice
partner (same specialty) is covering
inpatients that day and handles the
admission. Who reports what?
A. You decide who reports what, as only
one service may be reported for Medicare.
It’s common that these double services will
be time-consuming. The total time on the
date of the encounter may allow for
reporting of prolonged services. Be careful
to report the correct prolonged services G-
code.

Clarification for Admission/Discharge Services
Length of Stay Discharged On CPT® Codes
<8 hours Same calendar date as initial hospital inpatient or
observation care service
99221, 99222, 99223
8 or more hours Same calendar date as initial hospital inpatient or
99234, 99235, 99236
<8 hours Different calendar date as initial hospital inpatient or
99221, 99222, 99223
8 or more hours Different calendar date as initial hospital inpatient or
99221, 99222, 99223 and 99238,
99239

Misvalued Services Review
CPT® Code Current Work RVU RUC Recommended Work
RVU
Final 2024 CMS Work
RVU
99484 0.61 0.85 0.93
99497 1.50 1.50 1.50
99498 1.40 1.40 1.40
G0277 0.00 Practice Expense (PE)
Only
PE Only 5.43/5.47

Surgery

Musculoskeletal System – Vertebral Body Tethering (VBT)
• 22836 Anterior thoracic vertebral body
tethering, including thoracoscopy, when
performed; up to 7 vertebral segments
• 22837 Anterior thoracic vertebral body
performed; 8 or more vertebral
segments
• 22838 Revision (e.g., augmentation,
division of tether), replacement, or
removal of thoracic vertebral body
performed

Musculoskeletal System - Arthrodesis
• 27278 Arthrodesis, sacroiliac joint, percutaneous, with image guidance, including
placement of intra-articular implant(s) (e.g., bone allograft[s], synthetic device[s]),
without placement of transfixation device
• Replacement for deleted code 0775T Arthrodesis, sacroiliac joint, percutaneous, with image
guidance, includes placement of intra-articular implant(s) (e.g., bone allograft[s], synthetic
device[s])
• Existing code 27279 Arthrodesis, sacroiliac joint, percutaneous or minimally invasive
(indirect visualization), with image guidance, includes obtaining bone graft when
performed, and placement of transfixing device
• Replacement for deleted code 0809T Arthrodesis, sacroiliac joint, percutaneous or minimally
invasive (indirect visualization), with image guidance, placement of transfixing device(s) and
intra-articular implant(s), including allograft or synthetic device(s)

Musculoskeletal System – Hallux Valgus
• 28292 Correction, hallux valgus
(bunionectomy), with
sesamoidectomy, when performed;
with resection of proximal phalanx
base, when performed, any method
with proximal metatarsal osteotomy,
any method
• 28292 Correction, hallux valgus with
bunionectomy, with sesamoidectomy
when performed; with resection of
proximal phalanx base, when
performed, any method
when performed; with proximal
metatarsal osteotomy, any method
2024 versus 2023

with distal metatarsal osteotomy, any
method
with first metatarsal and medial
cuneiform joint arthrodesis, any
method
when performed; with distal
metatarsal osteotomy, any method
when performed; with first metatarsal
and medial cuneiform joint
arthrodesis, any method
2024 versus 2023

with proximal phalanx osteotomy, any
method
with double osteotomy, any method
when performed; with proximal
phalanx osteotomy, any method
when performed; with double
osteotomy, any method
2024 versus 2023

Respiratory System
• 31242 Nasal/sinus endoscopy, surgical; with destruction by
radiofrequency ablation, posterior nasal nerve
• 31243 Nasal/sinus endoscopy, surgical; with destruction by
cryoablation, posterior nasal nerve
• Bilateral procedure

Respiratory System
• Don’t confuse new codes with excision or destruction of intranasal lesion 30117-30118
CPT® Code Current Work RVU RUC Recommended
Work RVU
Final 2024 CMS Work
RVU
30117 3.26 3.91 3.91
30118 9.92 9.55 7.75
31242 N/A 2.70 2.70
31243 N/A 2.70 2.70

Cardiovascular System – Phrenic Nerve
• 33276 Insertion of phrenic nerve stimulator system (pulse generator and stimulating
lead[s]), including vessel catheterization, all imaging guidance, and pulse generator initial
analysis with diagnostic mode activation, when performed
• Possible replacement for code 0424T Insertion or replacement of neurostimulator system for
treatment of central sleep apnea; complete system (transvenous placement of right or left
stimulation lead, sensing lead, implantable pulse generator)
treatment of central sleep apnea; pulse generator only
• 33277 Insertion of phrenic nerve stimulator transvenous sensing lead (List separately in
addition to code for primary procedure)
treatment of central sleep apnea; sensing lead only

• 33278 Removal of phrenic nerve stimulator, including vessel catheterization, all imaging
guidance, and interrogation and programming, when performed; system, including pulse
generator and lead(s)
• 33279 Removal of phrenic nerve stimulator, including vessel catheterization, all imaging
guidance, and interrogation and programming, when performed; transvenous
stimulation or sensing lead(s) only
• Possible replacement for code 0429T Removal of neurostimulator system for treatment of
central sleep apnea; sensing lead only
• Possible replacement for code 0430T Removal of neurostimulator system for treatment of
central sleep apnea; stimulation lead only

• 33280 Removal of phrenic nerve stimulator, including vessel catheterization, all
imaging guidance, and interrogation and programming, when performed; pulse
generator only
• Possible replacement for code 0428T Removal of neurostimulator system for
• 33281 Repositioning of phrenic nerve stimulator transvenous lead(s)
• Possible replacement for code 0432T Repositioning of neurostimulator
system for treatment of central sleep apnea; stimulation lead only
• Possible replacement for code 0433T Repositioning of neurostimulator
system for treatment of central sleep apnea; sensing lead only

• 33287 Removal and replacement of phrenic nerve stimulator, including vessel
catheterization, all imaging guidance, and interrogation and programming, when
performed; pulse generator
• Possible replacement for code 0431T Removal and replacement of neurostimulator system
for treatment of central sleep apnea, pulse generator only
• 33288 Removal and replacement of phrenic nerve stimulator, including vessel
catheterization, all imaging guidance, and interrogation and programming, when
performed; transvenous stimulation or sensing lead(s)
treatment of central sleep apnea; sensing lead only
treatment of central sleep apnea; stimulation lead only

Male Genitourinary System
• 52284 Cystourethroscopy, with mechanical urethral dilation and urethral therapeutic
drug delivery by drug-coated balloon catheter for urethral stricture or stenosis, male,
including fluoroscopy, when performed
• Performed on the urethral stricture
• Replaces 0499T Cystourethroscopy, with mechanical dilation and urethral therapeutic
drug delivery for urethral stricture or stenosis, including fluoroscopy, when performed
• Caution: 0619T Cystourethroscopy with transurethral anterior prostate commissurotomy
and drug delivery, including transrectal ultrasound and fluoroscopy, when performed
• Performed on the prostate

Female Genitourinary System
• 58580 Transcervical ablation of uterine fibroid(s), including intraoperative ultrasound
guidance and monitoring, radiofrequency
• Replacement for 0404T Transcervical uterine fibroid(s) ablation with ultrasound
guidance, radiofrequency
• Transcervical ablation of a fibroid
• Is not treatment of the endometrium – it is treatment of the fibroid
• Monitoring is inherent to the procedure, so it has been added to the descriptor
• Took this opportunity to create a new subsection “Other Procedures”

Nervous System – Responsive Neurostimulation
• 61889 Insertion of skull-mounted cranial neurostimulator pulse generator or receiver,
including craniectomy or craniotomy, when performed, with direct or inductive coupling,
with connection to depth and/or cortical strip electrode array(s)
• 61891 Revision or replacement of skull-mounted cranial neurostimulator pulse generator
or receiver with connection to depth and/or cortical strip electrode array(s)
• 61892 Removal of skull-mounted cranial neurostimulator pulse generator or receiver
with cranioplasty, when performed
• Cranial mounted implanted pulse generator (IPG) takes chronic electroencephalogram
(EEG) readings
• Device stimulates in response to abnormal EEG pattern
• Separately report the insertion of the electrodes

Nervous System – Responsive Neurostimulation

Nervous System – Spinal Neurostimulator
• 63685 Insertion or replacement of spinal
neurostimulator pulse generator or
receiver, requiring pocket creation and
connection between electrode array
and pulse generator or receiver
• 63688 Revision or removal of implanted
spinal neurostimulator pulse generator
or receiver, with detachable connection
to electrode array
• 63685 Insertion or replacement of spinal
receiver, direct or inductive coupling
• 63688 Revision or removal of implanted
spinal neurostimulator pulse generator
or receiver
2024 versus 2023

Nervous System – Peripheral Nerve Neurostimulator
• 64590 Insertion or replacement of
peripheral, sacral, or gastric
receiver, requiring pocket creation and
connection between electrode array
and pulse generator or receiver
• 64595 Revision or removal of peripheral,
sacral, or gastric neurostimulator pulse
generator or receiver, with detachable
connection to electrode array
• 64590 Insertion or replacement of
peripheral or gastric neurostimulator
pulse generator or receiver, direct or
inductive coupling
• 64595 Revision or removal of peripheral
or gastric neurostimulator pulse
generator or receiver
2024 versus 2023

Nervous System - Neurostimulator
CPT Code Current Work RVU RUC Recommended Work
RVU
Final 2024 CMS
Work RVU
63685 5.19 5.19 5.19
63688 5.30 4.35 4.35
64590 2.45 5.10 5.10
64595 1.78 3.79 3.79

Nervous System - Neurostimulator
• 64596 Insertion or replacement of percutaneous electrode array, peripheral nerve, with
integrated neurostimulator, including imaging guidance, when performed; initial
electrode array
• 64597 Insertion or replacement of percutaneous electrode array, peripheral nerve, with
integrated neurostimulator, including imaging guidance, when performed; each
additional electrode array (List separately in addition to code for primary procedure)
• 64598 Revision or removal of neurostimulator electrode array, peripheral nerve, with
integrated neurostimulator
• All three are contractor priced, so no Work RVUs provided

Neurostimulator Help
Nerve Insertion/Replacement
Pocket Creation
Connection between
electrode array and
IPG/receiver
Revision/Removal
Detachable connection
to array
Percutaneous
Insert/Replace
Integrated
neurostimulator
Revision/Removal
Integrated
neurostimulator
Spinal 63685 63688 0784T 0785T
Peripheral,
sacral,
gastric
64590 64595
Peripheral 64596, +64597 64598
Sacral 0786T 0787T
Posterior
tibial
0587T 0588T

Eye and Ocular Adnexa
• 67516 Suprachoroidal space injection of
pharmacologic agent (separate
procedure)
• Replaces 0465T Suprachoroidal injection
of a pharmacologic agent (does not
include supply of medication)

Eye and Ocular Adnexa
CPT® Code Current Work RVU RUC Recommended
Work RVU
Final 2024 CMS
Work RVU
65778 1.0 0.84 0.84
65579 2.50 1.75 1.75
65780 7.81 7.03 7.03

Radiology

Radiology – One Deletion
• 74710 Pelvimetry, with or without
placental localization
• No suggested replacement
• Was used to identify cephalo-pelvic
disproportion
• Vaginal birth should be done regardless
of pelvimetry

Radiology
• 75580 Noninvasive estimate of coronary fractional flow reserve (FFR) derived from augmentative
software analysis of the data set from a coronary computed tomography angiography, with
interpretation and report by a physician or other qualified health care professional
• Replaces several Category III codes
• 0501T Noninvasive estimated coronary fractional flow reserve (FFR) derived from coronary
computed tomography angiography data using computation fluid dynamics physiologic
simulation software analysis of functional data to assess the severity of coronary artery
disease; data preparation and transmission, analysis of fluid dynamics and simulated
maximal coronary hyperemia, generation of estimated FFR model, with anatomical data
review in comparison with estimated FFR model to reconcile discordant data, interpretation
and report
disease; data preparation and transmission

Radiology
• Replaces several Category III codes, continued
disease; analysis of fluid dynamics and simulated maximal coronary hyperemia, and
generation of estimated FFR model
disease; anatomical data review in comparison with estimated FFR model to reconcile
discordant data, interpretation and report

Radiology
• 76984 Ultrasound, intraoperative thoracic aorta (e.g., epiaortic), diagnostic
• 76987 Intraoperative epicardial cardiac ultrasound (i.e., echocardiography) for congenital
heart disease, diagnostic; including placement and manipulation of transducer, image
acquisition, interpretation and report
heart disease, diagnostic; placement, manipulation of transducer, and image acquisition
only
heart disease, diagnostic; interpretation and report only
CPT® Code Current Work
RVU
RUC Recommended
Work RVU
Final 2024 CMS
Work RVU
76998 1.20 1.20 0.91

Pathology and
Laboratory

Pathology and Laboratory
• 81171 AFF2 (AF4/FMR2 family,
member 2 [FMR2]) (e.g., fragile X
mental retardation 2 [FRAXE]) gene
analysis; evaluation to detect
abnormal (e.g., expanded) alleles
• 81172 AFF2 (AF4/FMR2 family,
member 2 [FMR2]) (e.g., fragile X
mental retardation 2 [FRAXE]) gene
analysis; characterization of alleles
(e.g., expanded size and methylation
status)
• 81171 AFF2 (ALF transcription
elongation factor 2 [FMR2]) (e.g.,
fragile X intellectual disability 2
[FRAXE]) gene analysis; evaluation to
detect abnormal (e.g., expanded)
alleles
• 81172 AFF2 (ALF transcription
elongation factor 2 [FMR2]) (e.g.,
fragile X intellectual disability 2
[FRAXE]) gene analysis;
characterization of alleles (e.g.,
expanded size and methylation status)
2024 versus 2023

• 81243 FMR1 (fragile X mental
retardation 1) (e.g., fragile X mental
retardation) gene analysis; evaluation
to detect abnormal (e.g., expanded)
alleles
• 81244 FMR1 (fragile X mental
retardation 1) (e.g., fragile X mental
retardation) gene analysis;
expanded size and promoter
methylation status)
• 81243 FMR1 (fragile X messenger
ribonucleoprotein 1) (e.g., fragile X
syndrome, X-linked intellectual
disability [XLID]) gene analysis;
evaluation to detect abnormal (e.g.,
expanded) alleles
• 81244 FMR1 (fragile X messenger
ribonucleoprotein 1) (e.g., fragile X
syndrome, X-linked intellectual
disability [XLID]) gene analysis;
expanded size and promoter
methylation status)
2024 versus 2023

• Change term from mental retardation to intellectual disability
• 81403 Molecular pathology procedure, Level 4
• Also removes [K]-specific from parenthetical after full gene sequence KDM5D

GSPs and Other Molecular Multianalyte Assays
• Definitions
• Cell-free nucleic acid: DNA or RNA released into the blood and other body fluids. Cell-free
nucleic acid released from fetal cells can be sampled for non-invasive prenatal testing (NIPT)
while that released from tumor cells can be sampled for cancer, sometimes referred to as
tumor liquid biopsy.
• Copy number variants (CNVs): structural changes in the genome which are composed of large
deletions or duplications. CNVs can be found in the germline but can also occur in somatic
cells. See also Duplication/Deletion (Dup/Del). Duplications may also be referred to as
amplifications
• Duplication/Deletion (Dup/Del): terms that are usually used together with the "/" to refer to
molecular testing, which assesses the dosage of a particular genomic region. The region
tested is typically of modest to substantial size, from several dozen to several million or more
nucleotides. Normal gene dosage is two copies per cell, except for the sex chromosomes (X
and Y). Thus, zero or one copy represents a deletion, and three (or more) copies represent a
duplication.

• Definitions, cont.
• Low-pass sequencing: a method of genome sequencing intended for cytogenomic analysis of
chromosomal abnormalities, such as that performed for trait mapping or copy number
variation, typically performed to an average depth of sequencing ranging from 0.1 to 5X.
• Massively parallel sequencing (MPS): high-throughput method used to determine a portion
of the nucleotide sequences in an individual patient's genome, utilizing advanced (non-
Sanger) sequencing technologies that are capable of processing multiple DNA and/or RNA
sequences in parallel. While other technologies exist, next-generation sequencing (NGS) is a
common technique used to achieve MPS.
• Microsatellite instability (MSI): a type of DNA hypermutation or predisposition to mutation in
which replication errors are not corrected due to defective DNA mismatch repair (dMMR)
mechanism. MSI manifests as insertions or deletions in short tandem repeat (STR) (defined in
the molecular pathology guidelines) alleles and can be identified by changes in the DNA
repeat sequence length.

• Definitions, cont.
• Rearrangements: structural chromosomal variations such as deletions, insertions, inversions
(defined in the molecular pathology guidelines), or translocations (defined in the molecular
pathology guidelines) that bring together genetic material that is not normally adjacent in
the unmodified genome. It can manifest as abnormal gene expression or as an abnormal
fusion product at the RNA and/or protein level. Rearrangement can also refer to the process
by which immunoglobulin and T cell receptor genes are normally modified.
• Tumor mutational burden (TMB): the number of somatic mutations detected per million
bases (Mb) of genomic sequence investigated from a cancer specimen. It is usually obtained
from analysis using a next generation sequencing method. It is considered a biomarker to
guide immunotherapy decisions for patients with cancer.

Genomic Sequencing Procedures (GSPs) &
Other Molecular Multianalyte Assays
• 81445 Targeted genomic sequence analysis
panel, solid organ neoplasm, 5-50 genes
(eg, ALK, BRAF, CDKN2A, EGFR, ERBB2, KIT,
KRAS, MET, NRAS, PDGFRA, PDGFRB, PGR,
PIK3CA, PTEN, RET), interrogation for
sequence variants and copy number variants
or rearrangements, if performed; DNA
analysis or combined DNA and RNA analysis
• 81445 Solid organ neoplasm, genomic
sequence analysis panel, 5-50 genes,
interrogation for sequence variants
and copy number variants or
rearrangements, if performed; DNA
analysis or combined DNA and RNA
analysis
2024 versus 2023

GSPs & Other MMAs
• 81449 Targeted genomic sequence
analysis panel, solid organ neoplasm,
5-50 genes (eg, ALK, BRAF, CDKN2A,
EGFR, ERBB2, KIT, KRAS, MET, NRAS,
PDGFRA, PDGFRB, PGR, PIK3CA,
PTEN, RET), interrogation for
sequence variants and copy number
variants or rearrangements, if
performed; RNA analysis
sequence analysis panel, 5-50 genes,
interrogation for sequence variants
and copy number variants or
rearrangements, if performed; RNA
analysis
2024 versus 2023

GSPs & Other MMAs
analysis panel, hematolymphoid
neoplasm or disorder, 5-50 genes (eg,
BRAF, CEBPA, DNMT3A, EZH2, FLT3,
IDH1, IDH2, JAK2, KIT, KRAS, MLL,
NOTCH1, NPM1, NRAS), interrogation for
sequence variants, and copy number
variants or rearrangements, or isoform
expression or mRNA expression levels, if
performed; DNA analysis or combined
DNA and RNA analysis
• 81450 Hematolymphoid neoplasm or
disorder, genomic sequence analysis
panel, 5-50 genes, interrogation for
expression or mRNA expression levels,
if performed; DNA analysis or
combined DNA and RNA analysis
2024 versus 2023

GSPs & Other MMAs
analysis panel, hematolymphoid
neoplasm or disorder, 5-50 genes (eg,
BRAF, CEBPA, DNMT3A, EZH2, FLT3,
IDH1, IDH2, JAK2, KIT, KRAS, MLL,
NOTCH1, NPM1, NRAS), interrogation
for sequence variants, and copy
number variants or rearrangements,
or isoform expression or mRNA
expression levels, if performed; RNA
analysis
• 81451 Hematolymphoid neoplasm or
disorder, genomic sequence analysis
panel, 5-50 genes, interrogation for
expression or mRNA expression levels,
if performed; RNA analysis
2024 versus 2023

GSPs & Other MMAs
panel, solid organ or hematolymphoid
neoplasm or disorder, 51 or greater genes
(eg, ALK, BRAF, CDKN2A, CEBPA, DNMT3A,
EGFR, ERBB2, EZH2, FLT3, IDH1, IDH2, JAK2,
KIT, KRAS, MET, MLL, NOTCH1, NPM1,
NRAS, PDGFRA, PDGFRB, PGR, PIK3CA,
PTEN, RET), interrogation for sequence
variants and copy number variants or
rearrangements, or isoform expression or
mRNA expression levels, if performed; DNA
analysis or combined DNA and RNA analysis
• 81455 Solid organ or
hematolymphoid neoplasm or
disorder, 51 or greater genes, genomic
sequence analysis panel, interrogation
for sequence variants and copy
expression levels, if performed; DNA
analysis or combined DNA and RNA
analysis
2024 versus 2023

GSPs & Other MMAs
panel, solid organ or hematolymphoid
neoplasm or disorder, 51 or greater genes (eg,
ALK, BRAF, CDKN2A, CEBPA, DNMT3A, EGFR,
ERBB2, EZH2, FLT3, IDH1, IDH2, JAK2, KIT,
KRAS, MET, MLL, NOTCH1, NPM1, NRAS,
PDGFRA, PDGFRB, PGR, PIK3CA, PTEN, RET),
interrogation for sequence variants and copy
number variants or rearrangements, or isoform
expression or mRNA expression levels, if
performed; RNA analysis
• 81456 Solid organ or
hematolymphoid neoplasm or
disorder, 51 or greater genes, genomic
sequence analysis panel, interrogation
for sequence variants and copy
expression levels, if performed; RNA
analysis
2024 versus 2023

sequence analysis panel, interrogation for
sequence variants; DNA analysis,
microsatellite instability
sequence variants; DNA analysis, copy
number variants and microsatellite instability
sequence variants; DNA analysis or
combined DNA and RNA analysis, copy
number variants, microsatellite instability,
tumor mutation burden, and rearrangements

GSPs & Other MMAs
• 81462 Solid organ neoplasm, genomic sequence analysis panel, cell-free nucleic acid (eg,
plasma), interrogation for sequence variants; DNA analysis or combined DNA and RNA
analysis, copy number variants and rearrangements
plasma), interrogation for sequence variants; DNA analysis, copy number variants, and
microsatellite instability
plasma), interrogation for sequence variants; DNA analysis or combined DNA and RNA
analysis, copy number variants, microsatellite instability, tumor mutation burden, and
rearrangements

GSPs & Other MMAs
• What is coming for 2025?
• Review current Expanded Genetic
Disease Carrier or Diagnostic Panel
Testing
• Develop code(s) for Basic Genetic
Disease Panel Testing
• Development of a code for
Hereditary Pan-Cancer Panel Testing
• Review current practice for Lynch
Syndrome/Hereditary Nonpolyposis
Colorectal Cancer (HNPCC) Panel
Testing

• 81517 Liver disease, analysis of 3
biomarkers (hyaluronic acid [HA],
procollagen III amino terminal peptide
[PIIINP], tissue inhibitor of
metalloproteinase 1 [TIMP-1]), using
immunoassays, utilizing serum,
prognostic algorithm reported as a risk
score and risk of liver fibrosis and liver-
related clinical events within 5 years
• Replacement for code 0014M
• 82166 Anti-mullerian hormone (AMH)

• 86041 Acetylcholine receptor (AChR); binding antibody
• 86042 Acetylcholine receptor (AChR); blocking antibody
• 86043 Acetylcholine receptor (AChR); modulating antibody
• 86366 Muscle-specific kinase (MuSK) antibody
• 87523 Infectious agent detection by nucleic acid (DNA or RNA); hepatitis D (delta),
quantification, including reverse transcription, when performed

• 87467 Hepatitis B surface antigen
(HBsAg), quantitative
• 87467 Infectious agent antigen
detection by immunoassay technique
(eg, enzyme immunoassay [EIA],
enzyme-linked immunosorbent assay
[ELISA], fluorescence immunoassay
[FIA], immunochemiluminometric
assay [IMCA]), qualitative or
semiquantitative; hepatitis B surface
antigen (HBsAg), quantitative
2024 versus 2023

Multianalyte Assays
with Algorithmic
Analyses (MAAA)

MAAA – One Deletion
• Deleted: 0014M Liver disease, analysis of 3 biomarkers (hyaluronic acid [HA],
procollagen III amino terminal peptide [PIIINP], tissue inhibitor of
metalloproteinase 1 [TIMP-1]), using immunoassays, utilizing serum, prognostic
algorithm reported as a risk score and risk of liver fibrosis and liver-related clinical
events within 5 years
• See CPT® code 81517

Proprietary
Laboratory Analyses
(PLA)

PLA
• 0351U Infectious disease (bacterial or
viral), biochemical assays, tumor
necrosis factor-related
apoptosisinducing ligand (TRAIL),
interferon gamma-induced protein-10
(IP-10), and C-reactive protein, serum,
algorithm reported as likelihood of
bacterial infection
• 0351U Infectious disease (bacterial or
viral), biochemical assays, tumor
necrosis factor-related
apoptosisinducing ligand (TRAIL),
interferon gamma-induced protein-10
(IP-10), and C-reactive protein, serum,
or venous whole blood, algorithm
reported as likelihood of bacterial
infection
• MeMed BV® test
2024 versus 2023

PLA
• 0356U Oncology (oropharyngeal),
evaluation of 17 DNA biomarkers using
droplet digital PCR (ddPCR), cell-free
DNA, algorithm reported as a
prognostic risk score for cancer
recurrence
• 0356U Oncology (oropharyngeal or
anal), evaluation of 17 DNA
biomarkers using droplet digital PCR
(ddPCR), cell-free DNA, algorithm
reported as a prognostic risk score for
cancer recurrence
• NavDX® test
2024 versus 2023

PLA
• 0420U Oncology (urothelial), mRNA expression profiling by real-time quantitative PCR of MDK,
HOXA13, CDC2, IGFBP5, and CXCR2 in combination with droplet digital PCR (ddPCR) analysis of 6
single-nucleotide polymorphisms (SNPs) genes TERT and FGFR3, urine, algorithm reported as a
risk score for urothelial carcinoma
• Cxbladder Detect+
• 0421U Oncology (colorectal) screening, quantitative real-time target and signal amplification of 8
RNA markers (GAPDH, SMAD4, ACY1, AREG, CDH1, KRAS, TNFRSF10B, EGLN2) and fecal
hemoglobin, algorithm reported as a positive or negative for colorectal cancer risk
• Colosense™
• 0423U Oncology (pan-solid tumor), analysis of DNA biomarker response to anti-cancer therapy
using cell-free circulating DNA, biomarker comparison to a previous baseline pre-treatment cell-
free circulating DNA analysis using next-generation sequencing, algorithm reported as a
quantitative change from baseline, including specific alterations, if appropriate
• Guardant360 Response™

PLA
• 0423U Psychiatry (e.g., depression, anxiety), genomic analysis panel, including variant analysis of
26 genes, buccal swab, report including metabolizer status and risk of drug toxicity by condition
• Genomind® Pharmacogenetics Report – Full
• 0424U Oncology (prostate), exosome-based analysis of 53 small noncoding RNAs (sncRNAs) by
quantitative reverse transcription polymerase chain reaction (RT-qPCR), urine, reported as no
molecular evidence, low-, moderate- or elevated-risk of prostate cancer
• miR Sentinel™ Prostate Cancer Test
• 0425U Genome (e.g., unexplained constitutional or heritable disorder or syndrome), rapid
sequence analysis, each comparator genome (e.g., parents, siblings)
• RCIGM Rapid Whole Genome Sequencing, Comparator Genome
• 0426U Genome (e.g., unexplained constitutional or heritable disorder or syndrome), ultra-rapid
sequence analysis
• RCIGM Ultra-Rapid Whole Genome Sequencing

PLA
• 0427U Monocyte distribution width, whole blood (List separately in addition to code for primary
procedure)
• Early Sepsis Indicator
• 0428U Oncology (breast), targeted hybrid-capture genomic sequence analysis panel, circulating
tumor DNA (ctDNA) analysis of 56 or more genes, interrogation for sequence variants, gene copy
number amplifications, gene rearrangements, microsatellite instability, and tumor mutation
burden
• Epic Sciences ctDNA Metastatic Breast Cancer Panel
• 0429U Human papillomavirus (HPV), oropharyngeal swab, 14 high-risk types (i.e., 16, 18, 31, 33,
35, 39, 45, 51, 52, 56, 58, 59, 66, and 68)
• Omnipathology Oropharyngeal HPV PCR Test
• 0430U Gastroenterology, malabsorption evaluation of alpha-1-antitrypsin, calprotectin,
pancreatic elastase and reducing substances, feces, quantitative
• Malabsorption Evaluation Panel

PLA
• 0431U Glycine receptor alpha1 IgG, serum or cerebrospinal fluid (CSF), live cell-binding
assay (LCBA), qualitative
• Glycine Receptor Alpha1 IgG
• 0432U Kelch-like protein 11 (KLHL11) antibody, serum or cerebrospinal fluid (CSF), cell-
binding assay, qualitative
• Kelch-Like Protein 11 Antibody
• 0433U Oncology (prostate), 5 DNA regulatory markers by quantitative PCR, whole blood,
algorithm, including prostate-specific antigen, reported as likelihood of cancer
• EpiSwitch® Prostate Screening Test (PSE)
• 0434U Drug metabolism (adverse drug reactions and drug response), genomic analysis
panel, variant analysis of 25 genes with reported phenotypes
• RightMed® Gene Test Exclude F2 and F5

PLA
• 0435U Oncology, chemotherapeutic drug cytotoxicity assay of cancer stem cells
(CSCs), from cultured CSCs and primary tumor cells, categorical drug response
reported based on cytotoxicity percentage observed, minimum of 14 drugs or
drug combinations
• ChemoID®
• 0436U Oncology (lung), plasma analysis of 388 proteins, using aptamer-based
proteomics technology, predictive algorithm reported as clinical benefit from
immune checkpoint inhibitor therapy
• PROphet® NSCLC Test
• 0437U Psychiatry (anxiety disorders), mRNA, gene expression profiling by RNA
sequencing of 15 biomarkers, whole blood, algorithm reported as predictive risk
score
• MinX One™ Blood Test - Anxiety

PLA
• 0438U Drug metabolism (adverse drug
reactions and drug response), buccal
specimen, gene-drug interactions,
variant analysis of 33 genes, including
deletion/duplication analysis of CYP2D6,
including reported phenotypes and
impacted gene-drug interactions
• EffectiveRX™ Comprehensive Panel

Medicine

Vaccines and Toxoids
• 90589 Chikungunya virus vaccine, live attenuated, for intramuscular use
• 90623 Meningococcal pentavalent vaccine, conjugated Men A, C, W, Y- tetanus toxoid
carrier, and Men B-FHbp, for intramuscular use
• 90683 Respiratory syncytial virus vaccine, mRNA lipid nanoparticles, for intramuscular
use

Otorhinolaryngologic Services
• 92622 Diagnostic analysis, programming, and verification of an auditory osseointegrated
sound processor, any type; first 60 minutes
• 92623 Diagnostic analysis, programming, and verification of an auditory osseointegrated
sound processor, any type; each additional 15 minutes (List separately in addition to
code for primary procedure)

Coronary Therapeutic Services
• 92972 Percutaneous transluminal coronary lithotripsy (List separately in addition to code
for primary procedure)
• (Use 92972 in conjunction with 92920, 92924, 92928, 92933, 92937, 92941, 92943,
92975)
• Replaces 0715T Percutaneous transluminal coronary lithotripsy (List separately in
• Frequently called intravascular lithotripsy (IVL)
• Alternative to coronary rotational atherectomy or orbital atherectomy
• Heavily calcified coronary arteries that won’t dilate with traditional techniques

Implanted Phrenic Nerve System
• 93150 Therapy activation of implanted phrenic nerve stimulator system, including all
interrogation and programming
• 93151 Interrogation and programming (minimum one parameter) of implanted phrenic
nerve stimulator system
• Replaces 0435T Programming evaluation of implanted neurostimulator pulse generator
system for central sleep apnea in one session
• 93152 Interrogation and programming of implanted phrenic nerve stimulator system
during polysomnography
• Replaces 0436T Programming evaluation of implanted neurostimulator pulse generator
system for central sleep apnea during sleep study
• 93153 Interrogation without programming of implanted phrenic nerve stimulator system
• Replaces 0434T Interrogation evaluation of implanted neurostimulator pulse generator
system for central sleep apnea

Venography for Congenital Heart Defect(s)
• 93584 Venography for congenital heart defect(s), including catheter placement, and
radiological supervision and interpretation; anomalous or persistent superior vena cava
when it exists as a second contralateral superior vena cava, with native drainage to heart
(List separately in addition to code for primary procedure)
• Compare CPT® 75827 Venography, caval, superior, with serialography, radiological
supervision and interpretation for non-anomalous patient
radiological supervision and interpretation; azygos/hemiazygos venous system (List
separately in addition to code for primary procedure)
radiological supervision and interpretation; coronary sinus (List separately in addition to

Venography for Congenital Heart Defect(s)
radiological supervision and interpretation; venovenous collaterals originating at or
above the heart (e.g., from innominate vein) (List separately in addition to code for
primary procedure)
radiological supervision and interpretation; venovenous collaterals originating below the
heart (e.g., from the inferior vena cava) (List separately in addition to code for primary
procedure)
• Report once per session
• Report with 93593-93597 heart catheterization codes

Infusion and Injection
96446 Chemotherapy administration into
the peritoneal cavity via indwelling port
or catheter
96446 Chemotherapy administration into
the peritoneal cavity via implanted port
or catheter
2024 versus 2023

Hyperthermic Intraperitoneal Chemotherapy (HIPEC)
• 96547 Intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) procedure,
including separate incision(s) and closure, when performed; first 60 minutes (List
• 96548 Intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) procedure,
including separate incision(s) and closure, when performed; each additional 30 minutes
• Intra-abdominal tumor excision followed by HIPEC is an accepted treatment for
abdomen-related disorders
• Peritoneal
• Mesenteric
• Retroperitoneal

HIPEC
• Conducted intra-operatively
• Involves placement of an abdomen catheter for chemotherapy administration
• Variable time needed based on tumor-specific drug choice
• Should be reported in addition to the procedure to remove the tumor
• Guidelines discuss the pre-, intra- and post-procedure work
• CPT® parenthetical notes indicate the typical primary procedures, but is not an
exhaustive list
• Contractor priced at this time
• If no tumor removal, then CPT® 96446 is appropriate

Special Dermatological Procedures
• 96920 Laser treatment for
inflammatory skin disease (psoriasis);
total area less than 250 sq cm
250 sq cm to 500 sq cm
over 500 sq cm
• 96920 Excimer laser treatment for
psoriasis; total area less than 250 sq
cm
psoriasis; 250 sq cm to 500 sq cm
psoriasis; over 500 sq cm
2024 versus 2023

Physical Medicine and Rehabilitation Modalities
• 97037 Application of a modality to 1 or
more areas; low-level laser therapy (i.e.,
nonthermal and non-ablative) for post-
operative pain reduction
• This is under the Constant Attendance
section
• Entirely non-thermal
• Also known as a cold laser
• Promotes tissue healing
• Provides pain relief

Caregiver Training
• 97550 Caregiver training in strategies and techniques to facilitate the patient’s functional
performance in the home or community (e.g., activities of daily living [ADLs],
instrumental ADLs [iADLs], transfers, mobility, communication, swallowing, feeding,
problem solving, safety practices) (without the patient present), face to face; initial 30
minutes
• 97551 Caregiver training in strategies and techniques to facilitate the patient’s functional
performance in the home or community (e.g., activities of daily living [ADLs],
instrumental ADLs [iADLs], transfers, mobility, communication, swallowing, feeding,
problem solving, safety practices) (without the patient present), face to face; each
additional 15 minutes (List separately in addition to code for primary service)
• Allows caregivers to
• Understand patient’s treatment plan
• Obtain knowledge of outside resources to assist with patient care

Caregiver Training
• 97552 Group caregiver training in
strategies and techniques to facilitate the
patient's functional performance in the
home or community (e.g., activities of
daily living [ADLs], instrumental ADLs
[iADLs], transfers, mobility,
communication, swallowing, feeding,
problem solving, safety practices)
(without the patient present), face to
face with multiple sets of caregivers

CMS Definition of Caregiver
• Caregivers are broadly defined as family members, friends or neighbors who provide
unpaid assistance to a person with a chronic illness or disabling condition
AND
• Recognize, Assist, Include, Support, and Engage (RAISE) Family Caregivers Act definition
• an adult family member or other individual who has a significant relationship with, and who
provides a broad range of assistance to, an individual with a chronic or other health
condition, disability, or functional limitation

Conditions and Possible Training Topics
• Stroke
• Traumatic Brain Injury (TBI)
• Various forms of dementia
• Autism spectrum disorders
• Individuals with other intellectual or
cognitive disabilities
• Physical mobility limitations or necessary
use of assisted devices or mobility aids
• Assistance with challenging behaviors
• Help with safe transfers in the home to
avoid post-operative complications
• Assistance with medication management
• Assistance with feeding or swallowing
Must not duplicate payments made on
behalf of the patient under another
Medicare benefit category or Federal
program

Category III

Category III – Interventional Cardiology
• 0517T Insertion of wireless cardiac
stimulator for left ventricular pacing,
including device interrogation and
programming, and imaging supervision
and interpretation, when performed;
pulse generator component(s) (battery
and/or transmitter) only
• 0518T Removal of only pulse generator
component(s) (battery and/or
transmitter) of wireless cardiac
stimulator for left ventricular pacing
• 0517T Insertion of wireless cardiac
programming, and imaging supervision
and interpretation, when performed;
both components of pulse generator
(battery and transmitter) only
• 0518T Removal of pulse generator for
wireless cardiac stimulator for left
ventricular pacing; battery component
only
2024 versus 2023

• 0519T Removal and replacement of
ventricular pacing; pulse generator
transmitter)
ventricular pacing; pulse generator
transmitter), including placement of a
new electrode
pulse generator for wireless cardiac
programming; both components
(battery and transmitter)
pulse generator for wireless cardiac
programming; battery component
only
2024 versus 2023

Category III – Neurostimulator for Bladder
Dysfunction
• 0587T Percutaneous implantation or
replacement of integrated single
device neurostimulation system
including electrode array and receiver
or pulse generator, including analysis,
programming, and imaging guidance
when performed, posterior tibial
nerve
• 0587T Percutaneous implantation or
replacement of integrated single
device neurostimulation system for
bladder dysfunction including
electrode array and receiver or pulse
generator, including analysis,
nerve
2024 versus 2023

Category III – Neurostimulator for Bladder
Dysfunction
• 0588T Revision or removal of
integrated single device
neurostimulation system including
nerve
percutaneously placed integrated
single device neurostimulation system
for bladder dysfunction including
nerve
2024 versus 2023

Category III – Neurostimulator for Bladder Dysfunction
• 0589T Electronic analysis with simple programming of implanted integrated
neurostimulation system for bladder dysfunction (eg, electrode array and receiver),
including contact group(s), amplitude, pulse width, frequency (Hz), on/off cycling, burst,
dose lockout, patient-selectable parameters, responsive neurostimulation, detection
algorithms, closed-loop parameters, and passive parameters, when performed by
physician or other qualified health care professional, posterior tibial nerve, 1-3
parameters
• 0590T Electronic analysis with complex programming of implanted integrated
neurostimulation system for bladder dysfunction (eg, electrode array and receiver),
including contact group(s), amplitude, pulse width, frequency (Hz), on/off cycling, burst,
dose lockout, patient-selectable parameters, responsive neurostimulation, detection
algorithms, closed-loop parameters, and passive parameters, when performed by
physician or other qualified health care professional, posterior tibial nerve, 4 or more
parameters

Category III – Near-infrared Spectroscopy
• 0640T Noncontact near-infrared
spectroscopy studies of flap or wound
(e.g., for measurement of
deoxyhemoglobin, oxyhemoglobin,
and ratio of tissue oxygenation
[StO2]); image acquisition,
interpretation and report, each flap or
wound
• 0640T Noncontact near-infrared
spectroscopy (e.g., for measurement
of deoxyhemoglobin, oxyhemoglobin,
and ratio of tissue oxygenation), other
than for screening for peripheral
arterial disease, image acquisition,
interpretation, and report; first
anatomic site
2024 versus 2023

Category III - VBT
• 0656T Vertebral body tethering,
anterior; up to 7 vertebral segments
• 0657T Vertebral body tethering,
anterior; 8 or more vertebral
segments
• 0656T Anterior lumbar or
thoracolumbar vertebral body
tethering; up to 7 vertebral segments
• 0657T Anterior lumbar or
thoracolumbar vertebral body
tethering; 8 or more vertebral
segments
2024 versus 2023

Category III – Peripheral Transcutaneous
Magnetic Stimulation (TMS)
• 0766T Transcutaneous magnetic
stimulation by focused low-frequency
electromagnetic pulse, peripheral
nerve, initial treatment, with
identification and marking of the
treatment location, including
noninvasive electroneurographic
localization (nerve conduction
localization), when performed; first
nerve
nerve, with identification and marking
of the treatment location, including
localization), when performed; first
nerve
2024 versus 2023

Category III TMS
nerve, initial treatment, with
identification and marking of the
treatment location, including
localization), when performed; each
additional nerve (List separately in
addition to code for primary
procedure)
nerve, with identification and marking
of the treatment location, including
localization), when performed; each
additional nerve (List separately in
addition to code for primary
procedure)
2024 versus 2023

Category III – Neurostimulator Procedures
• 0784T Insertion or replacement of
percutaneous electrode array, spinal, with
integrated neurostimulator, including
imaging guidance, when performed
neurostimulator electrode array, spinal, with
• 0786T Insertion or replacement of
percutaneous electrode array, sacral, with
integrated neurostimulator, including
imaging guidance, when performed
neurostimulator electrode array, sacral, with

Category III – Neurostimulator Procedures
• 0788T Electronic analysis with simple programming of implanted integrated
neurostimulation system (e.g., electrode array and receiver), including contact group(s),
amplitude, pulse width, frequency (Hz), on/off cycling, burst, dose lockout, patient-
selectable parameters, responsive neurostimulation, detection algorithms, closed-loop
parameters, and passive parameters, when performed by physician or other qualified
health care professional, spinal cord or sacral nerve, 1-3 parameters
• 0789T Electronic analysis with complex programming of implanted integrated
neurostimulation system (e.g., electrode array and receiver), including contact group(s),
amplitude, pulse width, frequency (Hz), on/off cycling, burst, dose lockout, patient-
selectable parameters, responsive neurostimulation, detection algorithms, closed-loop
parameters, and passive parameters, when performed by physician or other qualified
health care professional, spinal cord or sacral nerve, 4 or more parameters

Category III - VBT
• 0790T Revision (e.g., augmentation, division of tether), replacement, or removal of
thoracolumbar or lumbar vertebral body tethering, including thoracoscopy, when
performed
• Added to simplify the coding for anterior thoracic tethering codes and
lumbar/thoracolumbar codes
• 22836-22838 is for the thoracic spine
• 0656T-0657T is for the thoracolumbar or lumbar

Category III - Uroflowmetry
• 0811T Remote multi-day complex
uroflowmetry (e.g., calibrated electronic
equipment); set-up and patient education on
use of equipment
• 0812T Remote multi-day complex
uroflowmetry (e.g., calibrated electronic
equipment); device supply with automated
report generation, up to 10 days
• Differ from remote physiologic monitoring
because of the length of monitoring
• Patients able to urinate into a special device
at home and results are transmitted to the
provider
• Multiday and multi-void schedule

Category III – Digestive System
• 0813T Esophagogastroduodenoscopy,
flexible, transoral, with volume
adjustment of intragastric bariatric
balloon

Category III - Musculoskeletal
• 0814T Percutaneous injection of
calcium-based biodegradable
osteoconductive material, proximal
femur, including imaging guidance,
unilateral
• Fills in bone voids in the proximal
femur of patients
• Patient at risk for fracture, so may
have disorder such as osteoporosis
• Includes imaging guidance

Category III - Radiology
• 0815T Ultrasound-based radiofrequency
echographic multi-spectrometry (REMS),
bone-density study and fracture-risk
assessment, 1 or more sites, hips, pelvis,
or spine
• Non-ionizing energy
• Radiation free
• Alternative to dual-energy X-ray
absorptiometry (DXA)
• Ionizing radiation

Category III – Neurostimulator for Bladder Dysfunction
• 0816T Open insertion or replacement of integrated neurostimulation system for bladder
dysfunction including electrode(s) (e.g., array or leadless), and pulse generator or
receiver, including analysis, programming, and imaging guidance, when performed,
posterior tibial nerve; subcutaneous
• 0817T Open insertion or replacement of integrated neurostimulation system for bladder
dysfunction including electrode(s) (e.g., array or leadless), and pulse generator or
receiver, including analysis, programming, and imaging guidance, when performed,
posterior tibial nerve; subfascial
• 0818T Revision or removal of integrated neurostimulation system for bladder
dysfunction, including analysis, programming, and imaging, when performed, posterior
tibial nerve; subcutaneous
• 0819T Revision or removal of integrated neurostimulation system for bladder
dysfunction, including analysis, programming, and imaging, when performed, posterior
tibial nerve; subfascial

Category III – Psychedelic Medication Therapy
• 0820T Continuous in-person monitoring and intervention (e.g., psychotherapy, crisis
intervention), as needed, during psychedelic medication therapy; first physician or other
qualified health care professional, each hour
intervention), as needed, during psychedelic medication therapy; second physician or
other qualified health care professional, concurrent with first physician or other qualified
health care professional, each hour (List separately in addition to code for primary
procedure)
intervention), as needed, during psychedelic medication therapy; clinical staff under the
direction of a physician or other qualified health care professional, concurrent with first
physician or other qualified health care professional, each hour (List separately in

Category III – Insertion of Leadless Pacemaker
• 0823T Transcatheter insertion of permanent single-chamber leadless pacemaker, right
atrial, including imaging guidance (e.g., fluoroscopy, venous ultrasound, right atrial
angiography and/or right ventriculography, femoral venography, cavography) and device
evaluation (e.g., interrogation or programming), when performed
• 0824T Transcatheter removal of permanent single-chamber leadless pacemaker, right
atrial, including imaging guidance (e.g., fluoroscopy, venous ultrasound, right atrial
angiography and/or right ventriculography, femoral venography, cavography), when
performed
• 0825T Transcatheter removal and replacement of permanent single-chamber leadless
pacemaker, right atrial, including imaging guidance (e.g., fluoroscopy, venous ultrasound,
right atrial angiography and/or right ventriculography, femoral venography, cavography)
and device evaluation (e.g., interrogation or programming), when performed

Category III – Insertion of Leadless Pacemaker
• 0826T Programming device evaluation
(in person) with iterative adjustment of
the implantable device to test the
function of the device and select optimal
permanent programmed values with
analysis, review and report by a
physician or other qualified health care
professional, leadless pacemaker system
in single-cardiac chamber
• Device is about the size of a battery

Category III – Digitization of Slides
• 0827T Digitization of glass microscope slides for cytopathology, fluids, washings, or
brushings, except cervical or vaginal; smears with interpretation (List separately in
• 0828T Digitization of glass microscope slides for cytopathology, fluids, washings, or
brushings, except cervical or vaginal; simple filter method with interpretation (List
• 0829T Digitization of glass microscope slides for cytopathology, concentration technique,
smears, and interpretation (e.g., Saccomanno technique) (List separately in addition to
• 0830T Digitization of glass microscope slides for cytopathology, selective-cellular
enhancement technique with interpretation (e.g., liquid-based slide preparation
method), except cervical or vaginal (List separately in addition to code for primary
procedure)

• 0831T Digitization of glass microscope slides for cytopathology, cervical or vaginal (any
reporting system), requiring interpretation by physician (List separately in addition to
• 0832T Digitization of glass microscope slides for cytopathology, smears, any other
source; screening and interpretation (List separately in addition to code for primary
procedure)
source; preparation, screening and interpretation (List separately in addition to code for
primary procedure)
source; extended study involving over 5 slides and/or multiple stains (List separately in

• 0835T Digitization of glass microscope slides for cytopathology, evaluation of fine needle
aspirate; immediate cytohistologic study to determine adequacy for diagnosis, first
evaluation episode, each site (List separately in addition to code for primary procedure)
aspirate; immediate cytohistologic study to determine adequacy for diagnosis, each
separate additional evaluation episode, same site (List separately in addition to code for
primary procedure)
aspirate; interpretation and report (List separately in addition to code for primary
procedure)
• 0838T Digitization of glass microscope slides for consultation and report on referred
slides prepared elsewhere (List separately in addition to code for primary procedure)

• 0839T Digitization of glass microscope slides for consultation and report on referred
material requiring preparation of slides (List separately in addition to code for primary
procedure)
• 0840T Digitization of glass microscope slides for consultation, comprehensive, with
review of records and specimens, with report on referred material (List separately in
• 0841T Digitization of glass microscope slides for pathology consultation during surgery;
first tissue block, with frozen section(s), single specimen (List separately in addition to
each additional tissue block with frozen section(s) (List separately in addition to code for
primary procedure)

cytologic examination (e.g., touch preparation, squash preparation), initial site (List
cytologic examination (e.g., touch preparation, squash preparation), each additional site
• 0845T Digitization of glass microscope slides for immunofluorescence, per specimen;
initial single antibody stain procedure (List separately in addition to code for primary
procedure)
• 0846T Digitization of glass microscope slides for immunofluorescence, per specimen;
each additional single antibody stain procedure (List separately in addition to code for
primary procedure)

• 0847T Digitization of glass microscope slides for examination and selection of retrieved
archival (ie, previously diagnosed) tissue(s) for molecular analysis (e.g., KRAS mutational
analysis) (List separately in addition to code for primary procedure)
• 0848T Digitization of glass microscope slides for in situ hybridization (e.g., FISH), per
specimen; initial single probe stain procedure (List separately in addition to code for
primary procedure)
specimen; each additional single probe stain procedure (List separately in addition to
specimen; each multiplex probe stain procedure (List separately in addition to code for
primary procedure)

• 0851T Digitization of glass microscope slides for morphometric analysis, in situ
hybridization (quantitative or semiquantitative), manual, per specimen; initial single
probe stain procedure (List separately in addition to code for primary procedure)
hybridization (quantitative or semiquantitative), manual, per specimen; each additional
single probe stain procedure (List separately in addition to code for primary procedure)
hybridization (quantitative or semiquantitative), manual, per specimen; each multiplex
probe stain procedure (List separately in addition to code for primary procedure)

• 0854T Digitization of glass microscope slides for blood smear, peripheral, interpretation
by physician with written report (List separately in addition to code for primary
procedure)
• 0855T Digitization of glass microscope slides for bone marrow, smear interpretation (List
• 0856T Digitization of glass microscope slides for electron microscopy, diagnostic (List

Category III
• 0857T Opto-acoustic imaging, breast, unilateral, including axilla when performed, real-
time with image documentation, augmentative analysis and report (List separately in
• Report in conjunction with breast ultrasound procedures 76641, 76642
• Delivers laser light into breast at the time of ultrasound to create images
• Two wave lengths that view oxygenated blood and deoxygenated blood
• Caution: may be considered investigational by the payer
• 0858T Externally applied transcranial magnetic stimulation with concomitant
measurement of evoked cortical potentials with automated report
• Used to assess brain function within the context of an existing brain disease
• Parenthetical notes for other magnetic stimulation codes

Category III – Near-infrared Spectroscopy
• 0859T Noncontact near-infrared spectroscopy (e.g., for measurement of
deoxyhemoglobin, oxyhemoglobin, and ratio of tissue oxygenation), other than for
screening for peripheral arterial disease, image acquisition, interpretation, and report;
each additional anatomic site (List separately in addition to code for primary procedure)
• 0860T Noncontact near-infrared spectroscopy (e.g., for measurement of
deoxyhemoglobin, oxyhemoglobin, and ratio of tissue oxygenation), for screening for
peripheral arterial disease, including provocative maneuvers, image acquisition,
interpretation, and report, one or both lower extremities
• Replaces 0641T Noncontact near-infrared spectroscopy studies of flap or wound (e.g.,
for measurement of deoxyhemoglobin, oxyhemoglobin, and ratio of tissue oxygenation
[StO2]); image acquisition only, each flap or wound
• Replaces 0642T Noncontact near-infrared spectroscopy studies of flap or wound (e.g.,
for measurement of deoxyhemoglobin, oxyhemoglobin, and ratio of tissue oxygenation
[StO2]); interpretation and report only, each flap or wound

• 0861T Removal of pulse generator for
ventricular pacing; both components
(battery and transmitter)
• 0862T Relocation of pulse generator for
ventricular pacing, including device
interrogation and programming; battery
component only
• 0863T Relocation of pulse generator for
ventricular pacing, including device
interrogation and programming;
transmitter component only

Category III – Low-Intensity ESWT
• 0864T Low-intensity extracorporeal shock wave therapy involving corpus cavernosum,
low energy
• Li-ESWT involving the corpus cavernosum
• Used to treat erectile dysfunction
• CPT® 0101T Extracorporeal shock wave involving musculoskeletal system, not otherwise
specified should not be reported together when treating the same area

Category III - Radiology
• 0865T Quantitative magnetic resonance image (MRI) analysis of the brain with
comparison to prior magnetic resonance (MR) study(ies), including lesion identification,
characterization, and quantification, with brain volume(s) quantification and/or severity
score, when performed, data preparation and transmission, interpretation and report,
obtained without diagnostic MRI examination of the brain during the same session
• 0866T Quantitative magnetic resonance image (MRI) analysis of the brain with
comparison to prior magnetic resonance (MR) study(ies), including lesion detection,
characterization, and quantification, with brain volume(s) quantification and/or severity
score, when performed, data preparation and transmission, interpretation and report,
obtained with diagnostic MRI examination of the brain (List separately in addition to

Category III Deleted Codes
CPT
Code Long Description
Potential Replacement
Code(s)
0404T Transcervical uterine fibroid(s) ablation with ultrasound guidance, radiofrequency 58580
0424T
Insertion or replacement of neurostimulator system for treatment of central sleep
apnea; complete system (transvenous placement of right or left stimulation lead,
sensing lead, implantable pulse generator) 33276
0425T
apnea; sensing lead only
33277
33288
0426T
apnea; stimulation lead only 33288
0427T
apnea; pulse generator only
33276
33287
0428T
Removal of neurostimulator system for treatment of central sleep apnea; pulse
generator only 33280
0429T
Removal of neurostimulator system for treatment of central sleep apnea; sensing
lead only 33279

CPT
Code(s)
0430T
Removal of neurostimulator system for treatment of central sleep apnea; stimulation
lead only 33279
0431T
Removal and replacement of neurostimulator system for treatment of central sleep
apnea, pulse generator only 33287
0432T
Repositioning of neurostimulator system for treatment of central sleep apnea;
stimulation lead only 33281
0433T
Repositioning of neurostimulator system for treatment of central sleep apnea;
sensing lead only 33281
0434T
Interrogation device evaluation implanted neurostimulator pulse generator system
for central sleep apnea 93153
0435T
Programming device evaluation of implanted neurostimulator pulse generator
system for central sleep apnea; single session 93151
0436T
Programming device evaluation of implanted neurostimulator pulse generator
system for central sleep apnea; during sleep study 93152

0465T Suprachoroidal injection of a pharmacologic agent (does not include supply of medication) 67516
0499T
Cystourethroscopy, with mechanical dilation and urethral therapeutic drug delivery for urethral
stricture or stenosis, including fluoroscopy, when performed 52284
0501T
Noninvasive estimated coronary fractional flow reserve (FFR) derived from coronary computed
tomography angiography data using computation fluid dynamics physiologic simulation
software analysis of functional data to assess the severity of coronary artery disease; data
preparation and transmission, analysis of fluid dynamics and simulated maximal coronary
hyperemia, generation of estimated FFR model, with anatomical data review in comparison
with estimated FFR model to reconcile discordant data, interpretation and report 75580
0502T
software analysis of functional data to assess the severity of coronary artery disease; data
preparation and transmission 75580
0503T
software analysis of functional data to assess the severity of coronary artery disease; analysis of
fluid dynamics and simulated maximal coronary hyperemia, and generation of estimated FFR
model 75580

CPT
Code(s)
0504T
software analysis of functional data to assess the severity of coronary artery disease;
anatomical data review in comparison with estimated FFR model to reconcile discordant data,
interpretation and report 75580
0508T
Pulse-echo ultrasound bone density measurement resulting in indicator of axial bone mineral
density, tibia
0533T
Continuous recording of movement disorder symptoms, including bradykinesia, dyskinesia, and
tremor for 6 days up to 10 days; includes set-up, patient training, configuration of monitor, data
upload, analysis and initial report configuration, download review, interpretation and report
0534T
tremor for 6 days up to 10 days; set-up, patient training, configuration of monitor
0535T
tremor for 6 days up to 10 days; data upload, analysis and initial report configuration
0536T
tremor for 6 days up to 10 days; download review, interpretation and report

CPT
Code(s)
0641T
Noncontact near-infrared spectroscopy studies of flap or wound (eg, for measurement of
deoxyhemoglobin, oxyhemoglobin, and ratio of tissue oxygenation [StO2]); image acquisition
only, each flap or wound
0859T
0860T
0642T
Noncontact near-infrared spectroscopy studies of flap or wound (eg, for measurement of
deoxyhemoglobin, oxyhemoglobin, and ratio of tissue oxygenation [StO2]); interpretation and
report only, each flap or wound
0859T
0860T
0715T
Percutaneous transluminal coronary lithotripsy (List separately in addition to code for primary
procedure) 92972
0768T
Transcutaneous magnetic stimulation by focused low-frequency electromagnetic pulse,
peripheral nerve, subsequent treatment, including noninvasive electroneurographic localization
(nerve conduction localization), when performed; first nerve
0769T
Transcutaneous magnetic stimulation by focused low-frequency electromagnetic pulse,
peripheral nerve, subsequent treatment, including noninvasive electroneurographic localization
(nerve conduction localization), when performed; each additional nerve (List separately in

CPT
Code LongDescription
PotentialReplacement
Code(s)
0775T
Arthrodesis,sacroiliacjoint,percutaneous,withimageguidance,includesplacementofintra-
articularimplant(s)(eg,boneallograft[s],syntheticdevice[s]) 27278
0809T
Arthrodesis,sacroiliacjoint,percutaneousorminimallyinvasive(indirectvisualization),with
imageguidance,placementoftransfixingdevice(s)andintra-articularimplant(s),including
allograftorsyntheticdevice(s) 27279

References
• CY 2024 Medicare Physician Fee Schedule Final Rule
• https://www.cms.gov/medicare/medicare-fee-service-payment/physicianfeesched/pfs-
federal-regulation-notices/cms-1784-f
• CPT® Errata and Technical Corrections
• https://www.ama-assn.org/practice-management/cpt/cpt-errata-technical-corrections
• CMS Caregiver Partners
• https://www.cms.gov/training-education/partner-outreach-resources/partner-with-
cms/caregiver-partners#:~:text=Caregivers%20are%20broadly%20defined
• RAISE Family Caregiving Advisory Council
• https://acl.gov/programs/support-caregivers/raise-family-caregiving-advisory-council

References
• MLN® Matters Evaluation and Management (E/M), MLN006764
• https://www.cms.gov/outreach-and-education/medicare-learning-network-
mln/mlnproducts/downloads/eval-mgmt-serv-guide-icn006764.pdf

Questions?
Ardith Campbell, COC, CPC
hcwebinars@healthcatalyst.com

2024 CPT® Updates (Professional Services Focused) - Part 3

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