| | | | |
| Inpatient Only Code | 00176 | Anesth pharyngeal surgery | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 00192 | Anesth facial bone surgery | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 00211 | Anesth cran surg hemotoma | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 00214 | Anesth skull drainage | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 00215 | Anesth skull repair/fract | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 00474 | Anesth surgery of rib | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 00524 | Anesth chest drainage | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 00540 | Anesth chest surgery | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 00542 | Anesthesia removal pleura | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 00546 | Anesth lung chest wall surg | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 00560 | Anesth heart surg w/o pump | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 00561 | Anesth heart surg <1 yr | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 00562 | Anesth hrt surg w/pmp age 1+ | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 00567 | Anesth cabg w/pump | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 00580 | Anesth heart/lung transplnt | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 00604 | Anesth sitting procedure | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 00632 | Anesth removal of nerves | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 00792 | Anesth hemorr/excise liver | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 00794 | Anesth pancreas removal | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 00796 | Anesth for liver transplant | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 00844 | Anesth pelvis surgery | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 00846 | Anesth hysterectomy | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 00848 | Anesth pelvic organ surg | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 00864 | Anesth removal of bladder | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 00866 | Anesth removal of adrenal | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 00868 | Anesth kidney transplant | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 00882 | Anesth major vein ligation | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 00904 | Anesth perineal surgery | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 00908 | Anesth removal of prostate | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 00932 | Anesth amputation of penis | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 00934 | Anesth penis nodes removal | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 00936 | Anesth penis nodes removal | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 01140 | Anesth amputation at pelvis | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 01150 | Anesth pelvic tumor surgery | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 01212 | Anesth hip disarticulation | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 01232 | Anesth amputation of femur | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 01234 | Anesth radical femur surg | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 01272 | Anesth femoral artery surg | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 01274 | Anesth femoral embolectomy | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 01404 | Anesth amputation at knee | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 01442 | Anesth knee artery surg | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 01444 | Anesth knee artery repair | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 01486 | | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 | |
| Inpatient Only Code | 01502 | Anesth lwr leg embolectomy | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 01634 | Anesth shoulder joint amput | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 01636 | Anesth forequarter amput | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 01638 | | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 | |
| Inpatient Only Code | 01652 | Anesth shoulder vessel surg | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 01654 | Anesth shoulder vessel surg | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 01656 | Anesth arm-leg vessel surg | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 01756 | Anesth radical humerus surg | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 01990 | Support for organ donor | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 11004 | Debride genitalia & perineum | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 11005 | Debride abdom wall | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 11006 | Debride genit/per/abdom wall | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 11008 | Remove mesh from abd wall | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Breast procedures | 11971 | Other breast procedures (excludes breast reconstruction following medically necessary mastectomies for breast cancer) | | |
| Inpatient Only Code | 15756 | Free myo/skin flap microvasc | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 15757 | Free skin flap microvasc | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 15758 | Free fascial flap microvasc | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Blepharoplasty | 15820 | | | |
| Blepharoplasty | 15821 | | | |
| Blepharoplasty | 15822 | | | |
| Blepharoplasty | 15823 | | | |
| Abdominoplasty | 15830 | | | |
| Abdominoplasty | 15847 | | | |
| Inpatient Only Code | 16036 | Escharotomy addl incision | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Cutaneous Vascular Lesion Removal | 17106 | | | |
| Cutaneous Vascular Lesion Removal | 17107 | | | |
| Cutaneous Vascular Lesion Removal | 17108 | | | |
| Breast procedures | 19120 | Breast Cancer Biopsy (excisional) | | |
| Breast procedures | 19125 | Breast Cancer Biopsy (excisional) | | |
| Breast procedures | 19300 | Simple mastectomy and gynecomastia surgery (excludes radical and modified) | | |
| Breast procedures | 19301 | Breast Lumpectomy | | |
| Breast procedures | 19302 | Breast Lumpectomy | | |
| Breast procedures | 19303 | Simple mastectomy and gynecomastia surgery (excludes radical and modified) | | |
| Inpatient Only Code | 19305 | Mast radical | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 19306 | Mast rad urban type | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Breast procedures | 19316 | Other breast procedures (excludes breast reconstruction following medically necessary mastectomies for breast cancer) | | |
| Breast procedures | 19318 | Other breast procedures (excludes breast reconstruction following medically necessary mastectomies for breast cancer) | | |
| Breast procedures | 19325 | Other breast procedures (excludes breast reconstruction following medically necessary mastectomies for breast cancer) | | |
| Breast procedures | 19328 | Other breast procedures (excludes breast reconstruction following medically necessary mastectomies for breast cancer) | | |
| Breast procedures | 19330 | Other breast procedures (excludes breast reconstruction following medically necessary mastectomies for breast cancer) | | |
| Breast procedures | 19340 | Other breast procedures (excludes breast reconstruction following medically necessary mastectomies for breast cancer) | | |
| Breast procedures | 19342 | Other breast procedures (excludes breast reconstruction following medically necessary mastectomies for breast cancer) | | |
| Breast procedures | 19350 | Other breast procedures (excludes breast reconstruction following medically necessary mastectomies for breast cancer) | | |
| Breast procedures | 19357 | Other breast procedures (excludes breast reconstruction following medically necessary mastectomies for breast cancer) | | |
| Inpatient Only Code | 19361 | Brst rcnstj latsms drsi flap | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 19364 | Brst rcnstj free flap | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 19367 | Brst rcnstj 1 pdcl tram flap | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 19368 | Brst rcnstj 1pdcl tram anast | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 19369 | Brst rcnstj 2 pdcl tram flap | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Breast procedures | 19370 | Other breast procedures (excludes breast reconstruction following medically necessary mastectomies for breast cancer) | | |
| Breast procedures | 19371 | Other breast procedures (excludes breast reconstruction following medically necessary mastectomies for breast cancer) | | |
| Breast procedures | 19380 | Other breast procedures (excludes breast reconstruction following medically necessary mastectomies for breast cancer) | | |
| Viscosupplementation (Musculoskeletal) | 20610 | Preauthorization required for 20610GÇô20611 when used for visco-supplementation procedures regardless of viscosupplementation agent. | | |
| Viscosupplementation (Musculoskeletal) | 20611 | Preauthorization required for 20610GÇô20611 when used for visco-supplementation procedures regardless of viscosupplementation agent. | | |
| Inpatient Only Code | 20661 | Application of head brace | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 20664 | Application of halo | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 20802 | Replantation arm complete | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 20805 | Replant forearm complete | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 20808 | Replantation hand complete | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 20816 | Replantation digit complete | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 20824 | Replantation thumb complete | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 20827 | Replantation thumb complete | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 20838 | Replantation foot complete | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Oral, orthognathic, temporomandibular joint (TMJ) surgeries | 20910 | | | |
| Inpatient Only Code | 20955 | Fibula bone graft microvasc | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 20956 | Iliac bone graft microvasc | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 20957 | Mt bone graft microvasc | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 20962 | Other bone graft microvasc | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 20969 | Bone/skin graft microvasc | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 20970 | Bone/skin graft iliac crest | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Ablation | 20982 | Includes cardic ablation for bone, liver, kidney and prostate cancer | | |
| Ablation | 20983 | Includes cardic ablation for bone, liver, kidney and prostate cancer | | |
| Spinal fusion, decompression, kyphoplasty and vertebroplasty | 20999 | | | |
| Oral, orthognathic, temporomandibular joint (TMJ) surgeries | 21010 | | | |
| Inpatient Only Code | 21045 | Extensive jaw surgery | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Oral, orthognathic, temporomandibular joint (TMJ) surgeries | 21050 | | | |
| Oral, orthognathic, temporomandibular joint (TMJ) surgeries | 21060 | | | |
| Oral, orthognathic, temporomandibular joint (TMJ) surgeries | 21070 | | | |
| Prosthetics | 21081 | | | |
| Prosthetics | 21082 | | | |
| Prosthetics | 21084 | | | |
| Oral, orthognathic, temporomandibular joint (TMJ) surgeries | 21085 | | | |
| Oral, orthognathic, temporomandibular joint (TMJ) surgeries | 21100 | | | |
| Oral, orthognathic, temporomandibular joint (TMJ) surgeries | 21110 | | | |
| Oral, orthognathic, temporomandibular joint (TMJ) surgeries | 21116 | | | |
| Oral, orthognathic, temporomandibular joint (TMJ) surgeries | 21125 | | | |
| Oral, orthognathic, temporomandibular joint (TMJ) surgeries | 21127 | | | |
| Oral, orthognathic, temporomandibular joint (TMJ) surgeries | 21141 | | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 | |
| Oral, orthognathic, temporomandibular joint (TMJ) surgeries | 21142 | | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 | |
| Oral, orthognathic, temporomandibular joint (TMJ) surgeries | 21143 | | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 | |
| Oral, orthognathic, temporomandibular joint (TMJ) surgeries | 21145 | | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 | |
| Oral, orthognathic, temporomandibular joint (TMJ) surgeries | 21146 | | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 | |
| Oral, orthognathic, temporomandibular joint (TMJ) surgeries | 21147 | | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 | |
| Oral, orthognathic, temporomandibular joint (TMJ) surgeries | 21150 | | | |
| Oral, orthognathic, temporomandibular joint (TMJ) surgeries | 21151 | | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 | |
| Oral, orthognathic, temporomandibular joint (TMJ) surgeries | 21154 | | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 | |
| Oral, orthognathic, temporomandibular joint (TMJ) surgeries | 21155 | | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 | |
| Oral, orthognathic, temporomandibular joint (TMJ) surgeries | 21159 | | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 | |
| Oral, orthognathic, temporomandibular joint (TMJ) surgeries | 21160 | | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 | |
| Inpatient Only Code | 21179 | Reconstruct entire forehead | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 21180 | Reconstruct entire forehead | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 21182 | Reconstruct cranial bone | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 21183 | Reconstruct cranial bone | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 21184 | Reconstruct cranial bone | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Oral, orthognathic, temporomandibular joint (TMJ) surgeries | 21188 | | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 | |
| Oral, orthognathic, temporomandibular joint (TMJ) surgeries | 21193 | | | |
| Oral, orthognathic, temporomandibular joint (TMJ) surgeries | 21194 | | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 | |
| Oral, orthognathic, temporomandibular joint (TMJ) surgeries | 21195 | | | |
| Oral, orthognathic, temporomandibular joint (TMJ) surgeries | 21196 | | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 | |
| Oral, orthognathic, temporomandibular joint (TMJ) surgeries | 21198 | | | |
| Oral, orthognathic, temporomandibular joint (TMJ) surgeries | 21199 | | | |
| Oral, orthognathic, temporomandibular joint (TMJ) surgeries | 21206 | | | |
| Oral, orthognathic, temporomandibular joint (TMJ) surgeries | 21208 | | | |
| Oral, orthognathic, temporomandibular joint (TMJ) surgeries | 21210 | | | |
| Oral, orthognathic, temporomandibular joint (TMJ) surgeries | 21215 | | | |
| Oral, orthognathic, temporomandibular joint (TMJ) surgeries | 21240 | | | |
| Oral, orthognathic, temporomandibular joint (TMJ) surgeries | 21242 | | | |
| Oral, orthognathic, temporomandibular joint (TMJ) surgeries | 21243 | | | |
| Oral, orthognathic, temporomandibular joint (TMJ) surgeries | 21244 | | | |
| Oral, orthognathic, temporomandibular joint (TMJ) surgeries | 21247 | | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 | |
| Inpatient Only Code | 21255 | Reconstruct lower jaw bone | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 21268 | Revise eye sockets | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 21343 | Open tx dprsd front sinus fx | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 21344 | Open tx compl front sinus fx | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 21347 | Opn tx nasomax fx multple | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 21348 | Opn tx nasomax fx w/graft | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 21366 | Opn tx complx malar w/grft | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 21422 | Treat mouth roof fracture | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 21423 | Treat mouth roof fracture | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 21431 | Treat craniofacial fracture | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 21432 | Treat craniofacial fracture | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 21433 | Treat craniofacial fracture | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 21435 | Treat craniofacial fracture | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 21436 | Treat craniofacial fracture | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 21510 | Drainage of bone lesion | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 21602 | Exc ch wal tum w/o lymphadec | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 21603 | Exc ch wal tum w/lymphadec | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 21615 | Removal of rib | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 21616 | Removal of rib and nerves | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 21620 | Partial removal of sternum | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 21627 | Sternal debridement | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 21630 | Extensive sternum surgery | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 21632 | Extensive sternum surgery | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Surgery for obstructive sleep apnea | 21685 | | | |
| Inpatient Only Code | 21705 | Revision of neck muscle/rib | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 21740 | Reconstruction of sternum | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 21750 | Repair of sternum separation | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 21825 | Treat sternum fracture | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 22010 | I&d p-spine c/t/cerv-thor | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 22015 | I&d abscess p-spine l/s/ls | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Spinal fusion, decompression, kyphoplasty and vertebroplasty | 22100 | | | |
| Spinal fusion, decompression, kyphoplasty and vertebroplasty | 22101 | | | |
| Spinal fusion, decompression, kyphoplasty and vertebroplasty | 22102 | | | |
| Spinal fusion, decompression, kyphoplasty and vertebroplasty | 22103 | | | |
| Inpatient Only Code | 22110 | Remove part of neck vertebra | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 22112 | Remove part thorax vertebra | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |
| Inpatient Only Code | 22114 | Remove part lumbar vertebra | HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023 - level of care review only | |