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300 Shoppable Services
Procedure Name
Psychotherapy w/patient 30 minutes-90832
Psychotherapy w/patient 45 minutes-90834
Psychotherapy w/patient 60 minutes-90837
Family psychotherapy, not including patient, 50 min-90846
Family psychotherapy, including patient, 50 min-90847
Group psychotherapy-90853
New patient office or other outpatient visit, typically 30 min-99203
New patient office of other outpatient visit, typically 45 min-99204
New patient office of other outpatient visit, typically 60 min-99205
Patient office consultation, typically 40 min-99243
Patient office consultation, typically 60 min-99244
Initial new patient preventive medicine evaluation (18-39 years)-99385
Initial new patient preventive medicine evaluation (40-64 years)-99386
Basic metabolic panel-80048
Blood test, comprehensive group of blood chemicals-80053
Obstetric blood test panel-80055
Blood test, lipids (cholesterol and triglycerides)-80061
Kidney function panel test-80069
Liver function blood test panel-80076
Manual urinalysis test with examination using microscope-81000
Manual urinalysis test with examination using microscope-81001
Automated urinalysis test-81002
Automated urinalysis test-81003
PSA (prostate specific antigen)-84153
PSA (prostate specific antigen)-84154
Blood test, thyroid stimulating hormone (TSH)-84443
Blood count complete auto&auto difrntl wbc-85025
Complete blood count, automated-85027
Blood test, clotting time-85610
Coagulation assessment blood test-85730
CT scan, head or brain, without contrast-70450
MRI scan of brain before and after contrast-70553
X-Ray, lower back, minimum four views-72110
MRI scan of lower spinal canal-72148
CT scan, pelvis, with contrast-72193
MRI scan of leg joint-73721
CT scan of abdomen and pelvis with contrast-74177
Ultrasound of abdomen-76700
Us pregnant uterus after 1st trimest 1/1st gestation-76805
Ultrasound pelvis through vagina-76830
Mammography of one breast-77065
Mammography of both breasts-77066
Mammography, screening, bilateral-77067
Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with major complications or comorbidities-216
Spinal fusion except cervical without major comorbid conditions or complications (MCC)-460
Major joint replacement or reattachment of lower extremity without major comorbid conditions or complications (MCC).-470
Cervical spinal fusion without comorbid conditions (CC) or major comorbid conditions or complications (MCC).-473
Uterine and adnexa procedures for non-malignancy without comorbid conditions (CC) or major comorbid conditions or complications (MCC)-743
Removal of 1 or more breast growth, open procedure-19120
Shaving of shoulder bone using an endoscope-29826
Removal of one knee cartilage using an endoscope-29881
Tonsillectomy & adenoidectomy-42820
Esophagogastroduodenoscopy transoral diagnostic-43235
Egd transoral biopsy single/multiple-43239
Diagnostic examination of large bowel using an endoscope-45378
Biopsy of large bowel using an endoscope-45380
Removal of polyps or growths of large bowel using an endoscope-45385
Ultrasound examination of lower large bowel using an endoscope-45391
Removal of gallbladder using an endoscope-47562
Repair of groin hernia patient age 5 years or older-49505
Biopsy of prostate gland-55700
Laproscopy prostect retropubic rad w/nrv sparing robot-55866
Obstetric care for vaginal delivery, pre-and post- delivery care-59400
Obstetric care cesarean delivery, pre-and post- delivery care-59510
Routine obstetric care vaginal dlvry & postpartum care vb-59610
Injection substance spinal canal lower back/sacrum w/o img gdn-62322
Injection substance spinal canal lower back/sacrum w/img gdn-62323
Inj anesthetic &/steroid lower/sacral spine nerve root w/img gdn-64483
Removal of recurring cataract in lens capsule using laser-66821
Removal of cataract with insertion of lens-66984
Electrocardiogram, routine, with interpretation and report-93000
Insertion of catheter into left heart for diagnosis-93452
Sleep study-95810
Therapeutic procedure, 1 or more areas, each 15 minutes-97110
Removal implant deep-20680
Destruction neurolytic agent; other peripheral nerve or branch-64640
Circumcision age greater than 28 days-54161
Tympanostomy general anesthesia-69436
Strabismus surgery, recession or resection; 1 horizontal muscle-67311
Arthroscopy aided ant cruciate ligm rpr-agmntj-rcnstj-29888
Repair incomplete circumcision-54163
Adenoidectomy, primary; younger than age 12-42830
Orchiopexy inguinal or scrotal approach-54640
New eye exam & treatment-92018
Laryngoscopy w/wo tracheoscopy w/micro/telescope-31526
Repair initial inguinal hernia, age 6 mo-5 years; reducible-49500
Laparoscopic appendectomy-44970
Laparoscopy excise lesions-58662
Chemotherapy cns, requiring and including spinal puncture-96450
Tympanic membrane repair w/wo prepj perfor patch-69610
Destruction cutaneous vascular lesions; 10.0 to 50.0 sq cm-17107
Insj non-biodegradable drug delivery implant-11981
Prq skeletal fixation supracondylar/transcondylar humeral fractu-24538
Destruction cutaneous vascular lesions; over 50.0 sq cm-17108
Tendon sheath incision-26055
Arthroscopy, knee, w/meniscus repair (medial or lateral)-29882
Insertion intrauterine device iud-58300
Strabismus, recession or resection; 2 horizontal muscles-67312
Surgical arthroscopy shoulder capsulorrhaphy-29806
Repair eardrum structures initial/revision w/o osicle recnstj-69631
Chemodenervation 1 extremity 5 or more muscles-64644
Meatotomy, cutting of meatus (separate procedure); except infant-53020
Revision of unstable kneecap-27422
Destruction localized lesion retina, 1/>sess; photocoagulation-67210
Arthroscopy hip w-labral repair-29916
Chemodenervation one extremity 1-4 muscle-64642
Cystoscopy and treatment-52310
Chemodenerv muscle migraine-64615
Remove ventilating tube-69424
Mastectomy simple complete-19303
Destruction cutaneous vascular lesions; less than 10 sq cm-17106
Diagnostic lumbar spinal puncture-62270
Plastic operation of penis for straightening of chordee-54300
Partial hymenectomy revision hymenal ring-56700
Breast reduction-19318
Revise eye muscle-67314
Treat finger fracture each-26727
Repair umbilical hernia, age 5 years or older; reducible-49585
Probing nasolacrimal duct, w/wo irrigation; requiring gen anes-68811
Excision benign lesion mrgn xcp sk tg f-e-e-n-l-m 1.1-2.0cm-11442
Bronchoscopy, incl fluoro guidance, diagnostic, w/cell washing-31622
Tonsillectomy and adenoidectomy age 12-greater than-42821
Laparoscopy, surgical; repair initial inguinal hernia-49650
Repair of nasal septum-30520
Arthroscopy hip w-femoroplasty-29914
Arthroscopy knee synovectomy limited spx-29875
Tonsillectomy primary-secondary age 12-greater than-42826
Egd, balloon dilation esophagus <30 mm diam-43249
Lysis or excision of penile post-circumcision adhesions-54162
Arthroscopy knee abrasion arthrp-mlt drlg-microfx-29879
Submucous resection inferior turbinate, partial or complete-30140
Dx bronchoscope/lavage-31624
Chemodenervation extraocular muscle-67345
Incision lingual frenum frenotomy-41010
Lengthening or shortening of tendon, leg or ankle; single tendon-27685
Diagnostic bone marrow; biopsy(ies) and aspiration(s)-38222
Excision of ganglion, wrist (dorsal or volar); primary-25111
Nasal/sinus endoscopy, surgical; w/control of nasal hemorrhage-31238
Reduce testis torsion-54600
Repair intermediate f/e/e/n/l&/muc 2.5 cm/<-12051
Excision benign lesion mrgn xcp sk tg f-e-e-n-l-m 0.5cm-less-11440
Closure gastrostomy surg-43870
Reconstruction of urethra w-urtp skin flaps-54324
Excision benign lesion mrgn xcp sk tg t-a-l greater than 4.0 cm-11406
Arrest epiphyseal distal femur-27475
Incision and removal of foreign body, subq tissues; simple-10120
Excision benign lesion mrgn xcp sk tg f-e-e-n-l-m 0.6-1.0cm-11441
Mastectomy gynecomastia-19300
Cystourethroscopy-52000
Removal non-biodegradable drug delivery implant-11982
Injection(s); single or multiple trigger point(s), 1-2 muscle(s)-20552
Open treatment fracture distal tibia only-27827
Esophagogastroduodenoscopy, flexible foreign body removal-43247
Injection, anes agent &/ steroid; other peripheral nerve/branch-64450
Myringoplasty-69620
Arthroscopy, knee, debridement/shaving articular cartilage-29877
Arthroscopy hip w/acetabuloplasty-29915
Lithotripsy, extracorporeal shock wave-50590
Remove eyelid lesion chalazion anes req hospization single/mult-67808
Arthroscopy knee drlg osteochond dissecans int fixj-29887
Explore/treat eye socket-67412
Tenotomy, percutaneous, achilles tendon; local anesthesia-27605
Insert tunneled cv cath 5 yr/>-36561
Cysto/uretero w/lithotripsy &indwell stent insrt-52356
Excision benign lesion mrgn xcp sk tg f-e-e-n-l-m 2.1-3.0cm-11443
Closed treatment of nasal bone fracture; with stabilization-21320
Ligamentous reconstruction (augmentation), knee; extra-articular-27427
Arthroscopy knee lateral release-29873
Arthroscopy, knee, drilling osteochondritis dissecans lesion-29886
Decompression fasciotomy, leg; anterior&/lateral, &pst cmprt-27602
Removal tunneled cv cath-36590
Laparoscopy, surgical; orchiopexy for intra-abdominal testis-54692
Removal impacted cerumen requiring instrumentation, unilateral-69210
Open tx humeral epicondylar fracture-24575
Injection paravert f jnt l/s 1 lev-64493
Intravitreal injection pharmacologic agent-67028
Treatment extensive retinopathy photocoagulation-67228
Remove lower leg bone lesion-27635
Revision of foot tendon-28238
Insert tunneled cv cath under 5 yr-36560
Graft; ear cartilage, autogenous, to nose or ear-21235
Arthroscopy aid tx spineand-fx knee w-fixj-29851
Esophagoscopy, rigid, transoral; with removal of foreign body(s)-43194
Esophagogastroduodenoscopy submucosal injection-43236
Circumcision, w/clamp/other device w/block-54150
Reconstruction of urethra-54326
Chemodenerv saliv glands-64611
Remove eyelid lesion w/o clsr/w/simple dir closure-67840
Adjacent tissue transfer/rearrgmt, e/n/e/l defect 10 sq cm/<-14060
Injection; single or multiple trigger point, 3 or more muscles-20553
Aspiration and injection treatment bone cyst-20615
Removal implant superficial separate procedure-20670
Open treatment clavicular fracture, includes internal fixation-23515
Tenotomy, percutaneous, achilles tendon; general anesthesia-27606
Repair, secondary, disrupted ligament, ankle, collateral-27698
Tonsillectomy, primary or secondary; younger than age 12-42825
Excision benign lesion mrgn xcp sk tg s-n-h-f-g 0.5 cm-less than-11420
Removal w/reinsertion, non-biodegradable drug delivery implant-11983
Removal sutures under anesthesia same surgeon-15850
Open tx radialandulnar shaft fx w-fixj radiusandulna-25575
Injection procedure for hip arthrography; with anesthesia-27095
Gastrocnemius recession-27687
Ostectomy, excision of tarsal coalition-28116
Cystoscopy & ureter catheter-52005
Revision of penis corrj chordee/1st stage hypospadias rpr-54304
Repair blepharoptosis; frontalis muscle w suture/other material-67901
Adjt tis trns/reargmt f/c/c/m/n/a/g/h/f 10sqcm/<-14040
Ligamentous reconstruction knee intra-articular-27428
Rhinoplasty primary w-major septal repair-30420
Laparoscopy, abdomen, peritoneum, and omentum, diagnostic-49320
Removal of testis-54520
Tympnoplsty w-o mstdc 1st-revj w-osicle recnstj-69632
Excision benign lesion mrgn xcp sk tg t-a-l 2.1-3.0 cm-11403
Excision benign lesion mrgn xcp sk tg s-n-h-f-g 1.1-2.0cm-11422
Excision benign lesion mrgn xcp sk tg f-e-e-n-l-m greater- 4.0cm-11446
Biopsy muscle deep-20205
Open treatment humeral condylar fracture-24579
Percutaneous skeletal fixation distal radial fracture/epiphyseal-25606
Arthroscopy, knee, w/lysis of adhesions, w/wo manipulation-29884
Excision of neck cyst-42810
Chemodenervation of internal anal sphincter-46505
Repair initial inguinal hernia full term infant <6mo reducible-49495
Reconstruction of urethra w-smpl meatal advmnt-54322
Chemodenervation 1 extremity; each addl extremity, 1-4 muscle(s)-64643
Neuroplasty and/or transposition; ulnar nerve at elbow-64718
Excision benign lesion mrgn xcp sk tg s-n-h-f-g 0.6-1.0cm-11421
Excision benign lesion mrgn xcp sk tg s-n-h-f-g greater -4.0cm-11426
Repair intermediate s/a/t/e 2.5 cm/<-12031
Reconstruction of polydactylous digit, soft tissue and bone-26587
Open tx phalangeal shaft fracture prox/middle ea-26735
Arrest, hemiepiphyseal, distal femur or proximal tibia or fibula-27485
Remove/graft leg bone lesion-27638
Open tx distal fibular fracture lat malleolus-27792
Removal tunneled central venous catheter, w-o subq port or pump-36589
Chemodenervation muscle neck unilat for dystonia-64616
Repair blepharoptosis; levator resection/advancement, internal-67903
Removal foreign body from external auditory canal; w/anesthesia-69205
Removal of skin tags-11200
Excision benign lesion mrgn xcp sk tg t-a-l 1.1-2.0 cm-11402
Excision tumor neck les sc < 3 cm-21555
Prq skel fixj humrl cndylr fx medial-lat w-manj-24582
Excision or curettage of bone cyst or benign tumor of femur;-27355
Ankle arthroscopy/surgery-29891
Biopsy or excision of lymph node(s); open, deep cervical node(s)-38510
Adenoidectomy primary age 12/>-42831
Injection, anes; lumbar/thoracic (paravertebral sympathetic)-64520
Icapsular cataract xtrj insj io lens prsth 1 stg-66983
Repair blepharoptosis; levator resection/advancement, external-67904
Excision soft tis lesion external auditory canal-69145
Incision and drainage abscess simple-single-10060
Excision benign lesion mrgn xcp sk tg t-a-l 0.6-1.0 cm-11401
Breast augmentation with implant-19325
Reinsertion spinal fixation device-22849
Explore/treat elbow joint-24101
Ablation, soft tissue inferior turbinates, uni/bi; superficial-30801
Ablate inf turbinate submuc-30802
Sigmoidoscopy, flexible; with biopsy, single or multiple-45331
Anorectal exam, diagnostic, requiring anesthesia-45990
Repair umbilical hernia, younger than age 5 years; reducible-49580
Cystourethroscopy, with insertion of indwelling ureteral stent-52332
Urethromeatoplasty w-prtl exc dstl urtl sgm-53460
Revise penis/urethra-54332
Injection, anesth agent and/or steroid; greater occipital nerve-64405
Vitrectomy mechanical pars plana-67036
Excision benign lesion mrgn xcp sk tg s-n-h-f-g 2.1-3.0cm-11423
Repair, intermediate, neck, hands, feet/xtrnl genitalia; 2.5cm/<-12041
Repair complex trunk 2.6-7.5 cm-13101
Repair, complex, scalp, arms, and/or legs; 2.6 cm to 7.5 cm-13121
Excision tumor, face deep 2 cm/>-21014
Excise mandible lesion-21040
Open tx articular fracture mcp-ip joint ea-26746
Osteochondral knee autograft-27416
Removal of toe lesions-28108
Tenotomy, lengthening, or release, abductor hallucis muscle-28240
Reconstruction toe polydactyly-28344
Application of hip spica cast; 1 and one-half spica or both legs-29325
Arthroscopy, shoulder, surgical; repair of slap lesion-29807
Arthroscopy knee removal loose/foreign body-29874
Arthroscopy, knee, synovectomy, major, 2 or more compartments-29876
Bone marrow harvesting for transplantation; autologous-38232
Perirectal injection of sclerosing solution for prolapse-45520
Excision hydrocele unilateral-55040
Tympanoplasty w-o mastoidec 1st-revj prosth torp-69633
Repair intermediate s/a/t/e 2.6-7.5 cm-12032
Repair complex f/c/c/m/n/ax/g/h/f 1.1-2.5 cm-13131
Repair complex f/c/c/m/n/ax/g/h/f 2.6-7.5 cm-13132
Adjacent tissue transfer or rearrgmt, trunk; 10 sqcm or less-14000
Removal sutures under anesthesia other surgeon-15851
Open tx monteggia fracture dislocation elbow-24635
Open tx radial head-neck fracture-24665
Open treatment ulnar fracture proximal end-24685
Repair of nonunion or malunion, radius or ulna; without graft-25400
Optx patllr fx w-int fixj-patllcandsoft tiss rpr-27524
Arthroscopy aided pst cruciate ligm rpr-agmntj-rcnstj-29889
Excise inferior turbinate-30130
Endoscopy maxillary sinus-31267
Secondary urethral surgery-54344
Plastic rpr penis correct angulation-54360
Scrotoplasty simple-55175
Colposcopy of the cervix including upper/adjacent vagina;-57452
Laparoscopy remove adnexa-58661
Injection, anes agent &/steroid; intercostal nerve, single lvl-64420
Removal of lens material; intracapsular-66920
Extracapsular ctarac removal insj io lens prosth cplx wo ecp-66982
Excision chalazion single-67800
Excision external ear partial simple repair-69110
Bone graft, any donor area; minor or small (eg, dowel or button)-20900
Closed treatment of nasal bone fracture; without stabilization-21315
Arthrotomy, elbow, exploration, drainage/removal of foreign body-24000
Excision tumor arm/elbow les sc < 3 cm-24075
Select the procedure in question.
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Harvard Pilgrim SCOAST LW OP
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Tufts HMO POS PPO IP
Tufts CARELINK IP
Tufts HMO OP
Tufts POS PPO OP
Tufts CARELINK OP
Aetna COMM IP OP
Cigna IP
Cigna OP
United COMM IP OP
Tufts Public Plan COMM QHP IP
Tufts Public Plan COMM QHP OP
Allways HMO QHP IP
Allways HMO QHP OP
Allways PPO IP
Allways PPO OP
Coventry HCVM IP OP
Fallon COMM IP
Fallon COMM OP
Humana IP OP
Multiplan Clients IP OP
PHCS Clients IP OP
Unicare GIC IP
Unicare GIC OP
Beacon BMCHP (QHP) IP OP
Beacon BMC (NH products) IP OP
Beacon FCHP COMM IP OP
Beacon GIC (Certain Products) IP OP
Cigna Behavioral IP
United Behavioral (Optum) IP
Cigna Behavioral OP
United Behavioral (Optum) OP
Aetna Transplants IP
Aetna Transplants OP
Cigna Lifesource IP
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Interlink Transplant IP
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LifeTrac IP
LifeTrac OP
Optum/URN COMM IP
Optum/URN COMM CHD ONC OP
Optum/URN COMM OP
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