Active Medical Reviews: October 2021 Through September 2022

Published 10/15/2021

Service Type

CPT®/HCPCS Code

Code Description

Review Type

Ambulance

A0425

BLS/ALS mileage, per statute mile
(in combination with transport codes)

TPE
Pre-payment
Postpayment

Ambulance

A0426

ALS1, non-emergency

TPE
Pre-payment
Postpayment

Ambulance

A0427

ALS1, emergency

TPE
Pre-payment
Postpayment

Ambulance

A0428

BLS, non-emergency

TPE
Pre-payment
Postpayment

Ambulance

A0429

BLS, emergency

TPE
Pre-payment
Postpayment

Ambulance

A0431

Rotary wing air transport

TPE
Pre-payment
Postpayment

Ambulance

A0436

Rotary wing air mileage, per statute mile (in combination with air transport code)

TPE
Pre-payment
Postpayment

Drugs/Biologics

J0178

Aflibercept injection

TPE
Postpayment

Drugs/Biologics

J0897

Denosumab Injection

TPE
Postpayment

Drugs/Biologics

J1745

Infliximab; Not Biosimil, 10mg

TPE
Postpayment

Drugs/Biologics

J2778

Ranibizumab injection

TPE
Postpayment

Drugs/Biologics

J9312

Rituximab, injection, 10 mg

TPE
Postpayment

Laboratory

G0480

Drug test definitive 1–7 classes

TPE
Postpayment

Laboratory

G0481

Drug test, definitive, 8–14 classes

TPE
Postpayment

Laboratory

G0482

Drug test, definitive, 15–21 classes

TPE
Postpayment

Laboratory

G0483

Drug test, definitive, 22 or more classes

TPE
Postpayment

Laboratory

80305

Drug test, presumptive; direct optical observation

TPE
Postpayment

Laboratory

80306

Drug test, presumptive; instrument-assisted

TPE
Postpayment

Laboratory

80307

Drug test, presumptive; chemistry analyzers

TPE
Postpayment

Laboratory

88305

Tissue exam by pathologist

TPE
Postpayment

Laboratory

88307

Tissue exam by pathologist

TPE
Postpayment

Laboratory

88309

Tissue exam by pathologist

TPE
Postpayment

Laboratory

88312

Special stains; group 1

TPE
Postpayment

Radiology

71045

X-ray exam chest 1 view

TPE
Pre-payment
Postpayment

Radiology

71046

X-ray exam chest 2 views

TPE
Pre-payment
Postpayment

Radiology

77080

DXA, bone density axial

TPE
Pre-payment
Postpayment

Radiology

R0070

Transport portable X-ray

TPE
Postpayment

Radiology

R0075

Transport portable X-ray multiple

TPE
Postpayment

Radiology

Q0092

Set-up portable X-ray equipment

TPE
Postpayment

Therapeutic Procedures

97110

Therapeutic exercises

TPE
Pre-payment

Therapeutic Procedures

97112

Neuromuscular reeducation

TPE
Pre-payment

Therapeutic Procedures

97113

Aquatic therapy/exercises

TPE
Pre-payment

Therapeutic Procedures

97116

Gait training therapy

TPE
Pre-payment

Therapeutic Procedures

97140

Manual therapy, 1/> regions

TPE
Pre-payment

Therapeutic Procedures

97150

Group therapeutic procedures

TPE
Pre-payment

CPT® codes and modifiers begin with a numeric character and HCPCS codes and modifiers begin with an alpha character.
CPT® codes, descriptors and other data only are copyright © 2020 American Medical Association. All rights reserved. 

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