ModifiedBlue Cross Blue Shield - New MexicoPolicy N/A

Plastic and Reconstructive Surgery — Procedure Code List and Predetermination Guidance

Lists CPT/HCPCS procedure codes used in plastic/reconstructive surgery that are candidates for optional recommended clinical review (predetermination) and provides utilization management instructions for providers submitting to Blue Cross Blue Shield - New Mexico.

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicyPlastic and Reconstructive Surgery — Procedure Code List and Predetermination Guidance

Policy CodePolicy N/A

Change TypeAdded multiple temporary (T) and HCPCS codesexpanded code listing (material)

Effective DateJan 1, 2026

Next Review DateN/A

Key ActionSubmit listed procedure codes for Recommended Clinical Review (Predetermination) to avoid post-service review.

SourceLink

POLICY UPDATE CHANGES

Multiple new temporary CPT (T) codes (0829T through 0945T) and numerous HCPCS A- and C-series codes (wound matrices, skin substitutes, device C-codes) were added to the utilization management list with effective dates through 2026.

Several codes already effective before 2026 (examples: 0858T effective 10/1/2024; 0861T–0864T effective 2024–2025; various A-series entries effective 2022–2025) remain in the table.

~200+codes listed in document

1/1/2026majority effective date

12/31/2999typical ending date

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

new wound/device entries

Coverage Criteria Overview and Code Listings

Procedure and HCPCS/CPT Code Tables

Listed CPT/HCPCS/Unlisted Codesmixed

15832	Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh.
15833	Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg.
15834	Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip.
15835	Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock.
15836	Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm.
15837	Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand.
15838	Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad.
15839	Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area.
15847	Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure).
15876	Suction assisted lipectomy; head and neck.

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Endovascular Iliac/Femoral/Tibial Revascularization CodesCPT

37277	Revascularization, endovascular... femoral and popliteal territory; complex lesion, initial vessel.
37278	Revascularization... complex lesion, each additional vessel.
37279	Intravascular lithotripsy(ies), femoral and popliteal vascular territory.
37280	Revascularization... tibial and peroneal territory; straightforward lesion, initial vessel.
37281	Revascularization... tibial and peroneal territory; straightforward lesion, each additional vessel.
37282	Revascularization... tibial and peroneal territory; complex lesion, initial vessel.
37283	Revascularization... tibial and peroneal territory; complex lesion, each additional vessel.
37284	Revascularization... tibial and peroneal territory, with transluminal stent placement; straightforward lesion, initial vessel.
37285	Revascularization... tibial and peroneal territory, with transluminal stent placement; each additional vessel.
37286	Revascularization... tibial and peroneal territory, with transluminal stent placement; complex lesion, initial vessel.

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Maxillofacial / Craniofacial CodesCPT

21089	Unlisted maxillofacial prosthetic procedure.
21120	Genioplasty; augmentation.
21121	Genioplasty; sliding osteotomy, single piece.
21122	Genioplasty; sliding osteotomies, 2 or more.
21123	Genioplasty; sliding, augmentation with interpositional bone grafts.
21244	Reconstruction of mandible, extraoral, with transosteal bone plate.
21245	Reconstruction of mandible or maxilla, subperiosteal implant; partial.
21246	Reconstruction of mandible or maxilla, subperiosteal implant; complete.
21299	Unlisted craniofacial and maxillofacial procedure.

Spine / Head & Neck Musculoskeletal CodesCPT

21499	Unlisted musculoskeletal procedure, head.
21685	Hyoid myotomy and suspension.
21899	Unlisted procedure, neck or thorax.
22505	Manipulation of spine requiring anesthesia, any region.
22526	Percutaneous intradiscal electrothermal annuloplasty; single level.
22527	... each additional levels.
22586	Arthrodesis, pre-sacral interbody technique, L5-S1 interspace.
22836	Anterior thoracic vertebral body tethering; up to 7 vertebral segments.
22837	... 8 or more vertebral segments.

Spine/Orthopedic & Upper Extremity CodesCPT

22867	Insertion of interlaminar/interspinous process stabilization/distraction device; lumbar single level.
22868	... second level.
22869	Insertion... without open decompression or fusion; lumbar single level.
22870	... second level.
22899	Unlisted procedure, spine.
22999	Unlisted procedure, abdomen, musculoskeletal system.
23929	Unlisted procedure, shoulder.
24300	Manipulation, elbow, under anesthesia.
24999	Unlisted procedure, humerus or elbow.

Lower Extremity & Misc Musculoskeletal CodesCPT

25259	Manipulation, wrist, under anesthesia.
25999	Unlisted procedure, forearm or wrist.
26340	Manipulation, finger joint, under anesthesia, each joint.
26341	Manipulation, palmar fascial cord post enzyme injection, single cord.
26989	Unlisted procedure, hands or fingers.
27275	Manipulation, hip joint, requiring general anesthesia.
27278	Arthrodesis, sacroiliac joint, percutaneous, with image guidance.
27299	Unlisted procedure, pelvis or hip joint.

Foot/Ankle & Nasal Procedure CodesCPT

27860	Manipulation of ankle under general anesthesia.
27899	Unlisted procedure, leg or ankle.
28890	Extracorporeal shock wave, high energy, requiring anesthesia other than local.
28899	Unlisted procedure, foot or toes.
29799	Unlisted procedure, casting or strapping.
29999	Unlisted procedure, arthroscopy.
30468	Repair of nasal valve collapse with subcutaneous/submucosal lateral wall implant(s).
30469	Repair of nasal valve collapse with low energy, temperature-controlled subcutaneous remodeling.

Nasal/Sinus & Bronchoscopy CodesCPT

30999	Unlisted procedure, nose.
31242	Nasal/sinus endoscopy with RF ablation, posterior nasal nerve.
31243	Nasal/sinus endoscopy with cryoablation, posterior nasal nerve.
31299	Unlisted procedure, accessory sinuses.
31599	Unlisted procedure, larynx.
31660	Bronchoscopy including bronchial thermoplasty, 1 lobe.
31661	Bronchoscopy including bronchial thermoplasty, 2 or more lobes.

Pulmonary & Thoracic Tumor Ablation CodesCPT

32994	Ablation therapy for pulmonary tumor(s), percutaneous; cryoablation.
32998	Ablation therapy for pulmonary tumor(s), percutaneous; radiofrequency.
32999	Unlisted procedure, lungs and pleura.

Cardiac Device & Phrenic Stimulator CodesCPT

33211	Insertion/replacement of temporary transvenous dual chamber pacing electrodes.
33267	Exclusion of left atrial appendage, open.
33268	Exclusion of left atrial appendage, performed at time of other sternotomy.
33269	Exclusion of left atrial appendage, thoracoscopic.
33274	Transcatheter insertion or replacement of permanent leadless pacemaker, right ventricular.
33275	Transcatheter removal of permanent leadless pacemaker, right ventricular.
33276	Insertion of phrenic nerve stimulator system (pulse generator and leads).
33277	Insertion of phrenic nerve stimulator transvenous sensing lead.
33278	Removal of phrenic nerve stimulator; system.

Cardiac Monitoring & Implant CodesCPT

33279	Removal of phrenic nerve stimulator; transvenous leads only.
33280	Removal of phrenic nerve stimulator; pulse generator only.
33281	Repositioning of phrenic nerve stimulator transvenous lead(s).
33285	Insertion, subcutaneous cardiac rhythm monitor, including programming.
33287	Removal and replacement of phrenic nerve stimulator; pulse generator.
33288	Removal and replacement of phrenic nerve stimulator; transvenous leads.
33289	Transcatheter implantation of wireless pulmonary artery pressure sensor.

Vascular Embolization & Endovascular CodesCPT

33370	Transcatheter placement and removal of cerebral embolic protection device(s).
33418	Transcatheter mitral valve repair; initial prosthesis.
33419	Transcatheter mitral valve repair; additional prosthesis.
33542	Myocardial resection (eg, ventricular aneurysmectomy).
33999	Unlisted procedure, cardiac surgery.
36299	Unlisted procedure, vascular injection.

Venous Injection & Ablation CodesCPT

36465	Injection of non-compounded foam sclerosant; single incompetent trunkal vein.
36466	Injection of non-compounded foam sclerosant; multiple incompetent truncal veins.
36468	Injection(s) of sclerosant for spider veins.
36470	Injection of sclerosant; single incompetent vein.
36471	Injection of sclerosant; multiple incompetent veins same leg.
36473	Endovenous ablation therapy, mechanochemical; first vein.
36474	Endovenous ablation therapy, mechanochemical; subsequent veins.
36475	Endovenous ablation therapy, radiofrequency; first vein.

Additional Venous & Extracorporeal Therapy CodesCPT

36476	Endovenous ablation therapy, radiofrequency; subsequent veins.
36478	Endovenous ablation therapy, laser; first vein.
36479	Endovenous ablation therapy, laser; subsequent veins.
36522	Photopheresis, extracorporeal.
37215	Transcatheter placement of intravascular stent(s), cervical carotid artery; with distal embolic protection.

Embolization & Embolotherapy CodesCPT

37216	Transcatheter placement of intravascular stent(s), cervical carotid artery; without distal embolic protection.
37217	Transcatheter placement of intravascular stent(s), intrathoracic common carotid or innominate artery by retrograde treatment.
37218	Transcatheter placement of intravascular stent(s), intrathoracic common carotid or innominate artery, antegrade.
37241	Vascular embolization or occlusion; venous, other than hemorrhage.
37242	Vascular embolization or occlusion; arterial, other than hemorrhage or tumor.
37243	Vascular embolization or occlusion; for tumors, organ ischemia, or infarction.
37244	Vascular embolization or occlusion; for arterial or venous hemorrhage or lymphatic extravasation.
37254	Revascularization, endovascular, iliac vascular territory, transluminal angioplasty; straightforward lesion, initial vessel.

Unlisted Procedure Codes (Various Regions)CPT

21499	Unlisted musculoskeletal procedure, head.
22899	Unlisted procedure, spine.
22999	Unlisted procedure, abdomen, musculoskeletal system.

Listed CPT Codes (Selection)CPT

37260	Revascularization, endovascular, iliac vascular territory, stent placement; complex lesion, initial vessel.
37261	... each additional vessel.
37262	Intravascular lithotripsy, iliac vascular territory.
37263	Revascularization, femoral and popliteal territory; straightforward lesion, initial vessel.
37264	... each additional vessel.
37265	... complex lesion, initial vessel.
37266	... complex lesion, each additional vessel.
37267	Revascularization... femoral and popliteal territory; transluminal stent placement; straightforward lesion, initial vessel.
37268	... each additional vessel.
37269	... complex lesion, initial vessel.

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Predetermination, Prior Authorization, and Documentation Guidance

Prior Authorization

Submit for Recommended Clinical Review (Predetermination)

Listed procedure codes in this document are identified as candidates for an Optional Recommended Clinical Review (Predetermination). Submit a Recommended Clinical Review (Predetermination) to avoid post-service review of the listed procedures/services.

Recommended Clinical Review (Predetermination) is optional but advised for listed procedures to avoid post-service review.

Prior Authorization

Verify prior authorization requirements per listed code

Prior authorization may be required for many of the listed surgical and procedural CPT codes because they are included in the payer's utilization management code list; providers must verify PA requirements for each code and effective date.

Verify whether prior authorization is required for the exact CPT code and effective date before scheduling.

Background and Policy Scope

Background: this excerpt functions primarily as a utilization management code listing for procedures used across plastic and reconstructive surgery and related specialties. It is intended to identify services that are tracked by the payer and that may be candidates for Recommended Clinical Review (Predetermination), but it does not set out clinical indication criteria within the provided chunks.

Recommended Clinical Review (Predetermination) — definition and purpose

DefinitionRecommended Clinical Review (Predetermination) is an optional clinical review process recommended by the payer to assess medical necessity prior to service

PurposeHelps avoid post-service review and potential claim denial by confirming medical necessity before the procedure is performed

Provider actionSubmit a predetermination request for listed procedure codes when desired to reduce post-service risk

Effective Date / Ending Date — Dates shown indicate when the listed code becomes effective for utilization management and the open-ended ending date indicates ongoing applicability until revised.

Definitions and Notes on Code Types

Initial vessel / each additional vessel — definition used in vascular codes

Initial vesselCodes distinguish an initial vessel treated versus each additional vessel (billed separately)

UseSelect 'initial' code for the first vessel and 'each additional vessel' code for subsequent vessels within the same procedure

ExamplesRevascularization CPT codes (eg, 37256–37259, 37263–37276) follow this convention

Lesion complexity — 'straightforward' vs 'complex' lesion notes used to select codes

Lesion complexityProcedural CPT codes differentiate 'straightforward lesion' vs 'complex lesion' to determine appropriate code selection

Coding implicationChoose the 'complex lesion' code when procedural complexity meets the descriptor; 'each additional vessel' codes apply accordingly

Policy Changes and Document Updates

2026-01-01codes_addedLatest

Multiple new temporary Category III (T) procedure codes (e.g., 0829T–0840T and continuing through 0945T) were added to the utilization management listing with effective date 1/1/2026 and ending date 12/31/2999.

2024-10-01codes_added

Selected temporary and HCPCS codes with earlier effective dates were included in the list (examples: 0858T effective 10/1/2024).

2022-04-15hcpcs_codes_added

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicyPlastic and Reconstructive Surgery — Procedure Code List and Predetermination Guidance

Policy CodePolicy N/A

Change TypeAdded multiple temporary (T) and HCPCS codesexpanded code listing (material)

Effective DateJan 1, 2026

Next Review DateN/A

Key ActionSubmit listed procedure codes for Recommended Clinical Review (Predetermination) to avoid post-service review.

SourceLink

On This Page

Note

Use listed CPT/HCPCS codes and descriptions for authorization and coding

Use the CPT and HCPCS codes listed in the document (each entry includes code description and effective/ending dates) when preparing authorization requests and claims; the excerpt itself lists codes and effective dates but does not specify additional PA steps.

Refer to the listed code descriptions and dates when selecting codes for authorizations or claims.

Prior Authorization

Verify PA and code/date alignment before submission

Prior authorization and correct coding are implied for the procedures listed; verify coverage and PA requirements using the exact CPT code and its effective date from the utilization management listing before submission.

Confirm PA needs for the exact CPT code and date of service shown in the listing.

Prior Authorization

Codes included in utilization management may require PA

Certain procedure codes included in this file are tracked by the payer's utilization management process and may require prior authorization per payer UM rules; providers should treat codes in these sections as subject to utilization management.

Check the utilization management listing for the specific code and effective date to determine PA needs.

Documentation Required

Include device/implant procedures in utilization review

Device- and implant-related procedure codes (for example, osseointegrated skull implant codes 69729/69730 and auditory device programming codes 92622/92623) are listed and should be included in utilization review/prior authorization workflows when applicable.

Include device details (e.g., implant type, bony defect size where applicable) in review/authorization submissions.

Prior Authorization

Treat listed codes as subject to utilization management

Services billed with the codes enumerated in this section are subject to utilization management and prior authorization decisions; providers must verify individual code effective dates and PA requirements prior to service.

Confirm the exact code, effective date, and any PA rules before performing or billing the service.

Prior Authorization

Check PA for listed Category III (T) codes

Category III (temporary) and other procedure codes in the listing may be subject to utilization management and prior authorization per payer processes; check authorization requirements for each Category III code before providing the service.

Verify PA for Category III codes (T-codes) listed with their effective dates.

Documentation Required

Reference T-/U-code descriptions and effective dates when submitting

This segment enumerates many T- and U-series codes with descriptions and effective/ending dates; providers should use the code and date metadata from the listing when preparing requests, though the excerpt does not itself state specific authorization steps.

Reference the effective and ending dates shown for each T-/U-code when preparing authorization or billing.

Prior Authorization

Verify PA for listed T-codes (presence indicates UM tracking)

The presence of Category III/temporary CPT (T) codes in this list indicates they are tracked by the payer's utilization management processes; inclusion does not by itself state a PA requirement, so verify with the payer.

For each T-code, confirm whether PA is required per Blue Cross Blue Shield - New Mexico rules.

Prior Authorization

Confirm PA reference for Category III codes using exact code/date

These Category III and related codes are listed with descriptions and effective dates; prior authorization requirements (if any) should be confirmed using the exact code and effective date in the utilization management listing.

Confirm PA policies that reference the specific Category III code and its effective date.

Prior Authorization

Prior authorization may be required for listed temporary (T) codes

Prior authorization may be required for procedures billed with the temporary (T) codes shown; verify PA requirements with Blue Cross Blue Shield - New Mexico for each T-code and its effective date.

Do not assume T-codes are payable without PA — confirm per code.

Prior Authorization

Verify PA per T- and A-series HCPCS codes

Many temporary (T) and A-series HCPCS codes are included in the utilization management listing with effective/ending dates; providers must verify whether PA is required for each HCPCS/T-code before service.

Check PA requirements per HCPCS code and effective date in the UM listing.

Documentation Required

Skin substitute and device C-codes may require utilization review

Specific C-codes and skin substitute HCPCS entries (for example C9363 and other C-codes for skin substitutes/devices) are included in the utilization management code list and may be subject to prior authorization or utilization review.

Include product identifiers and size/quantity (per cm2 where listed) when requesting review or authorization for skin substitutes.

Prior Authorization

Confirm PA for HCPCS/C/D/E codes using exact code/date

Prior authorization may be required for services and items identified by the listed HCPCS/C/D/E codes per the payer's utilization management process; ensure the code and its effective date match the authorization request.

Use the exact HCPCS/C/D/E code and effective date from the listing when submitting PA requests.

Note

Search the PDF (Ctrl+F) to locate codes/descriptions

Use the search function (Ctrl+F) on the searchable PDF to quickly find procedure codes or descriptions in the utilization management file before preparing an authorization request or claim.

Search the document by code to confirm description and effective/ending dates prior to submission.

Documentation Required

Include code description and effective/ending dates from the listing

Each listed code entry includes metadata (code description, effective date, ending date, and optional notes); reference these elements when preparing authorization submissions or claims.

Include the exact code description and effective date from the listing in your submission.

Documentation Required

Document procedure details to match the exact code

Document the performed procedure with the exact CPT/HCPCS code and supporting operative, interventional, or device details that match the code description (for example, lesion complexity, vessel treated, device implanted) when submitting prior authorization or claims.

Provide operative reports, imaging, or device details that justify the selected code.

Documentation Required

Provide narrative/operative detail for unlisted procedure codes

For unlisted procedure codes (e.g., 51999, 53899, 54699, 55899), submit an operative narrative or detailed description of the procedure performed to support authorization or claim adjudication.

Include operative report and description when billing unlisted codes to avoid denial.

Documentation Required

Document programming and time for auditory device services (92622/92623)

When billing services for auditory osseointegrated device analysis and programming (92622/92623), document device programming, diagnostic analysis, and time units per the code descriptors (first 60 minutes for 92622; additional 15-minute units for 92623).

Record length of service and programming steps to support 92622/92623 billing.

Billing Rule

Use the exact listed code and date of service within effective range

Submit claims and prior authorization requests using the exact procedure code and date of service within the code's effective and ending date window as listed in the utilization management table.

Do not bill codes for dates outside the listed effective/ending date range.

Billing Rule

Bill using exact listed codes and effective dates

Providers must bill using the exact CPT/HCPCS codes listed with their corresponding effective dates as shown in the utilization management listing; mismatched codes or dates can affect processing.

Align the billed CPT/HCPCS code with the effective date shown in the list.

Denial Risk

Predetermination advised to avoid post-service review and denial

Failure to submit listed procedures/services for Recommended Clinical Review (Predetermination) may subject claims to post-service review and potential denial; predetermination is recommended to avoid post-service review.

Consider predetermination for listed procedures to reduce risk of post-service denial.

Denial Risk

Listed codes are subject to utilization management and possible PA

Claims for codes included in the listing may be subject to utilization management and prior authorization; verify UM/PA status for each listed procedure code before providing the service.

Confirm UM/PA status per code to prevent claim processing delays or denials.

Denial Risk

Denial risk for unlisted or mismatched codes/dates

Claims for procedures not matching the listed CPT code descriptions or billed outside the listed effective dates may be subject to utilization management review and potential denial.

Ensure code selection and date of service align with the listing to reduce denial risk.

Documentation Required

Unlisted codes require detailed justification to avoid denial

Unlisted procedure codes (for example 69799, 69949, 69979, 76496–76499, etc.) may require additional documentation or specification of the procedure performed and could trigger additional review or denial if unsupported.

Provide detailed operative reports or narratives when billing unlisted codes.

Denial Risk

Denial risk for codes outside listed effective dates

Claims or authorizations referencing codes not listed or outside the effective date ranges shown may be subject to utilization management denial or manual review; verify that the billed code is present and active in the payer's listing.

Cross-check the payer's code list for active effective dates before billing or requesting authorization.

Denial Risk

Coverage governed by code list and effective dates — verify prior to billing

The payer's code list and effective dates govern coverage processing; claims using codes not listed or with mismatched effective dates may be subject to utilization management review or denial.

Confirm the exact code and effective date in the UM listing prior to claim submission.

Documentation Required

T-code claims: ensure correct coding and supporting documentation

Claims for services using the listed temporary (T) codes may be subject to utilization management and require correct coding and appropriate prior authorization per payer rules; missing or incorrect coding can affect processing.

Provide supporting operative, pathology, or imaging reports when billing T-codes.

Denial Risk

Noncovered code A0888 — risk of denial

A0888 (Noncovered ambulance mileage) is listed as Noncovered; use of this code may trigger denial.

Do not expect coverage for ambulance mileage reported with A0888 as it is identified Noncovered.

Denial Risk

Denial risk when billing with incorrect code effective dates

Claims for codes billed prior to their effective date or not listed for the requested date may be denied; providers must bill using codes with the appropriate effective date from the listing.

Confirm the code's effective date in the listing before billing or submitting PA.

Effective date noteDates shown indicate when the listed code becomes effective for utilization management

Ending date noteAn open-ended ending date (commonly 12/31/2999) indicates ongoing applicability until revised

Billing implicationProviders must use the code with a date of service within its effective/ending date window

Digitization of glass microscope slides codes (0755T–0839T) — Category description

CategoryDigitization of glass microscope slides (T-codes 0755T–0839T, 0829T–0856T, etc.)

ScopeCovers digital capture, special stains, immunohistochemistry, morphometric analysis, cytopathology preparations, consultation and reporting

Effective datesMany entries effective 1/1/2026 with ending date 12/31/2999; some subcodes have earlier effective dates

Augmentative analysis codes — T-codes describing algorithmic/assistive analyses of imaging or physiologic data

Code typeAugmentative analysis T-codes (eg, 0877T–0880T) describe algorithmic/assistive analyses of imaging or physiologic data

ExamplesAugmentative CT interstitial lung disease classification (0877T–0880T) and other algorithmic image analyses

FunctionInclude data preparation/transmission and physician interpretation/reporting components as specified

Integra Meshed Bilayer Wound Matrix (C9363) — listed as a skin substitute with pricing and effective date

ItemIntegra Meshed Bilayer Wound Matrix (C9363) — skin substitute priced per square centimeter

Effective dateC9363 Effective Date = 5/15/2021

Ending dateEnding Date = 12/31/2999

ExamplesIliac and tibial revascularization codes include separate entries for straightforward vs complex lesions (see 37256–37299 series)

Revascularization codes (37294-37299) — description note

ScopeRevascularization codes (37294–37299) describe tibial/peroneal and inframalleolar endovascular procedures including angioplasty, stent placement, and atherectomy as applicable

Coding detailCodes distinguish initial vs each additional vessel and lesion complexity; include imaging and radiological supervision when performed

Effective datesMany entries effective 1/1/2026 with ending date 12/31/2999 as listed

Unlisted procedure codes — these require operative detail for adjudication

RequirementUnlisted procedure codes require submission of operative details or reports to adjudicate the billed service

ExamplesIncludes codes such as 37501, 37799, 39499, 69949, 76496–76499, 76999, etc.

Provider actionProvide narrative description and supporting documentation when billing unlisted procedure codes

69729 / 69730 — osseointegrated skull implant definitions

Codes69729 / 69730 describe implantation and replacement of osseointegrated skull implants with magnetic transcutaneous attachment to external speech processor

Bony defect referenceDescriptions reference bony defect thresholds (>= 100 sq mm) for code selection

Effective dates69729 Effective Date = 1/15/2025; 69730 Effective Date = 1/1/2023

92622 / 92623 — auditory osseointegrated device programming timing

Service92622/92623 — Diagnostic analysis, programming, and verification of an auditory osseointegrated sound processor

Timing92622 covers the first 60 minutes; 92623 billed for each additional 15-minute increment

DocumentationRecord minutes of service and device programming details to support units billed

0616U - 0627U series — DNA methylation assay series description

Series description0616U–0627U series are DNA methylation assay U-codes reported by clinical domain with algorithmic positive/negative risk output

Clinical domainsExamples include neurology (dementia), cardiovascular (ASCVD), psychiatry (bipolar) and others with specified site counts and effective dates

Effective datesMany U-codes listed effective 4/1/2026 with ending date 12/31/2999

Virtual reality procedural dissociation services (0770T–0774T) — category description

Category0770T–0774T describe virtual reality procedural dissociation services and related VR therapy support

Timing incrementsInitial and additional units are defined as initial 15 minutes and each additional 15 minutes intraservice time

Operational noteSome VR codes require presence of an independent trained observer and specify patient age criteria

Leadless pacemaker transcatheter codes (0795T–0804T, 0823T–0826T) — category description

ScopeLeadless pacemaker transcatheter codes (0795T–0804T, 0823T–0826T) cover insertion, removal, replacement, programming, and evaluation of single- and dual-chamber leadless systems

ComponentsSeparate codes exist for right atrial vs right ventricular components, complete systems, removals, and programming/evaluation

Effective datesMany codes effective 7/1/2023 or later with ending dates 12/31/2999

Digitization of glass microscope slides (T-codes) — Category III temporary codes describing digital capture and interpretation

CategoryDigitization of glass microscope slides (T-codes) are Category III temporary codes for digital capture and interpretation of pathology and cytology slides

ExamplesIncludes codes for concentration techniques, liquid-based preparations, immunofluorescence, in situ hybridization, consultation and reporting (0829T–0856T, 0755T–0839T ranges)

Effective datesMany entries effective 1/1/2026 with ending date 12/31/2999

D9999 / by report codes — unclassified dental/report-by-report code note

CodeD9999 and other D-series 'by report' dental codes require narrative/report describing the service

UsageUse when no specific dental code applies; include detailed documentation for adjudication

Effective datesD-codes shown have effective dates (example D0999 effective 10/24/2019) and ending date 12/31/2999

C9399 — Unclassified drugs or biologicals note

CodeC9399 — Unclassified drugs or biologicals

UsageUsed for drugs/biologicals not otherwise classified; requires specific description/reporting

Effective dateC9399 Effective Date = 1/1/2012; Ending Date = 12/31/2999

Multiple A- and C-series HCPCS wound matrix and skin substitute codes (for example A2014 Omeza collagen matrix and C9363 Integra Meshed Bilayer Wound Matrix) were added with effective dates between 2022 and 2026 and ending date 12/31/2999.