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Inpatient Only Code00176Anesth pharyngeal surgeryHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Inpatient Only Code00192Anesth facial bone surgeryHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Inpatient Only Code00211Anesth cran surg hemotomaHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Inpatient Only Code00214Anesth skull drainageHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Inpatient Only Code00215Anesth skull repair/fractHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Inpatient Only Code00474Anesth surgery of ribHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Inpatient Only Code00524Anesth chest drainageHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Inpatient Only Code00540Anesth chest surgeryHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Inpatient Only Code00542Anesthesia removal pleuraHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Inpatient Only Code00546Anesth lung chest wall surgHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Inpatient Only Code00560Anesth heart surg w/o pumpHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Inpatient Only Code00561Anesth heart surg <1 yrHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Inpatient Only Code00562Anesth hrt surg w/pmp age 1+HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Inpatient Only Code00567Anesth cabg w/pumpHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Inpatient Only Code00580Anesth heart/lung transplntHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Inpatient Only Code00604Anesth sitting procedureHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Inpatient Only Code00632Anesth removal of nervesHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Inpatient Only Code00792Anesth hemorr/excise liverHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Inpatient Only Code00794Anesth pancreas removalHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Inpatient Only Code00796Anesth for liver transplantHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Inpatient Only Code00844Anesth pelvis surgeryHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Inpatient Only Code00846Anesth hysterectomyHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Inpatient Only Code00848Anesth pelvic organ surgHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Inpatient Only Code00864Anesth removal of bladderHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Inpatient Only Code00866Anesth removal of adrenalHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Inpatient Only Code00868Anesth kidney transplantHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Inpatient Only Code00882Anesth major vein ligationHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Inpatient Only Code00904Anesth perineal surgeryHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Inpatient Only Code00908Anesth removal of prostateHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Inpatient Only Code00932Anesth amputation of penisHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Inpatient Only Code00934Anesth penis nodes removalHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Inpatient Only Code00936Anesth penis nodes removalHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Inpatient Only Code01140Anesth amputation at pelvisHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Inpatient Only Code01150Anesth pelvic tumor surgeryHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Inpatient Only Code01212Anesth hip disarticulationHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Inpatient Only Code01232Anesth amputation of femurHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Inpatient Only Code01234Anesth radical femur surgHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Inpatient Only Code01272Anesth femoral artery surgHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Inpatient Only Code01274Anesth femoral embolectomyHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Inpatient Only Code01404Anesth amputation at kneeHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Inpatient Only Code01442Anesth knee artery surgHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Inpatient Only Code01444Anesth knee artery repairHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Inpatient Only Code01502Anesth lwr leg embolectomyHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Inpatient Only Code01634Anesth shoulder joint amputHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Inpatient Only Code01636Anesth forequarter amputHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Inpatient Only Code01652Anesth shoulder vessel surgHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Inpatient Only Code01654Anesth shoulder vessel surgHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Inpatient Only Code01656Anesth arm-leg vessel surgHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Inpatient Only Code01756Anesth radical humerus surgHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Inpatient Only Code01990Support for organ donorHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Inpatient Only Code11004Debride genitalia & perineumHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Inpatient Only Code11005Debride abdom wallHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Inpatient Only Code11006Debride genit/per/abdom wallHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Inpatient Only Code11008Remove mesh from abd wallHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Breast Reconstruction11920Reconstruction of the breast or other than following mastectomyNotification or Prior Authorization is not required for certain diagnosis codes: Please reference the UHC Breast Recon Dx Codes TAB
Breast Reconstruction11921Reconstruction of the breast or other than following mastectomyNotification or Prior Authorization is not required for certain diagnosis codes: Please reference the UHC Breast Recon Dx Codes TAB
Breast Reconstruction11922Reconstruction of the breast or other than following mastectomyNotification or Prior Authorization is not required for certain diagnosis codes: Please reference the UHC Breast Recon Dx Codes TAB
Cosmetic & Reconstructive11960Cosmetic procedures that change or improve physical appearance, without significantly improving or restoring physiological function Reconstructive procedures that either treat a medical condition or improve or restore physiologic functionPreauth required for such services whether scheduled as inpatient or outpatient.
Cosmetic & Reconstructive11971Cosmetic procedures that change or improve physical appearance, without significantly improving or restoring physiological function Reconstructive procedures that either treat a medical condition or improve or restore physiologic functionPreauth required for such services whether scheduled as inpatient or outpatient.
Gender Dysphoria Treatment14000 This surgical codes with the following DX codes: F64.0, F64.1,F64.2,F64.8,F64.9,Z87.890
Gender Dysphoria Treatment14001 This surgical codes with the following DX codes: F64.0, F64.1,F64.2,F64.8,F64.9,Z87.890
Site of Service (SOS) - Outpatient Hospital14040Skin GraftPrior authorization is only required when requesting service in an outpatient hospital setting. Prior authorization is not required if performed at a participating Ambulatory Surgery Center (ASC) or in OFFICE
Gender Dysphoria Treatment14041 This surgical codes with the following DX codes: F64.0, F64.1,F64.2,F64.8,F64.9,Z87.890
Site of Service (SOS) - Outpatient Hospital14060Skin GraftPrior authorization is only required when requesting service in an outpatient hospital setting. Prior authorization is not required if performed at a participating Ambulatory Surgery Center (ASC) or in OFFICE
Site of Service (SOS) - Outpatient Hospital14301Skin GraftPrior authorization is only required when requesting service in an outpatient hospital setting. Prior authorization is not required if performed at a participating Ambulatory Surgery Center (ASC) or in OFFICE
Site of Service (SOS) - Outpatient Hospital15100Skin GraftPrior authorization is only required when requesting service in an outpatient hospital setting. Prior authorization is not required if performed at a participating Ambulatory Surgery Center (ASC) or in OFFICE
Site of Service (SOS) - Outpatient Hospital15120Skin GraftPrior authorization is only required when requesting service in an outpatient hospital setting. Prior authorization is not required if performed at a participating Ambulatory Surgery Center (ASC) or in OFFICE
Site of Service (SOS) - Outpatient Hospital15220Skin GraftPrior authorization is only required when requesting service in an outpatient hospital setting. Prior authorization is not required if performed at a participating Ambulatory Surgery Center (ASC) or in OFFICE
Site of Service (SOS) - Outpatient Hospital15240Skin GraftPrior authorization is only required when requesting service in an outpatient hospital setting. Prior authorization is not required if performed at a participating Ambulatory Surgery Center (ASC) or in OFFICE
Site of Service (SOS) - Outpatient Hospital15260Skin GraftPrior authorization is only required when requesting service in an outpatient hospital setting. Prior authorization is not required if performed at a participating Ambulatory Surgery Center (ASC) or in OFFICE
Gender Dysphoria Treatment15734 This surgical codes with the following DX codes: F64.0, F64.1,F64.2,F64.8,F64.9,Z87.890
Gender Dysphoria Treatment15738 This surgical codes with the following DX codes: F64.0, F64.1,F64.2,F64.8,F64.9,Z87.890
Gender Dysphoria Treatment15750 This surgical codes with the following DX codes: F64.0, F64.1,F64.2,F64.8,F64.9,Z87.890
Inpatient Only Code15756Free myo/skin flap microvascHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Gender Dysphoria Treatment15757Free skin flap microvascThis surgical codes with the following DX codes: F64.0, F64.1,F64.2,F64.8,F64.9,Z87.890 HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Gender Dysphoria Treatment15758Free fascial flap microvascThis surgical codes with the following DX codes: F64.0, F64.1,F64.2,F64.8,F64.9,Z87.890 HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Gender Dysphoria Treatment15775 This surgical codes with the following DX codes: F64.0, F64.1,F64.2,F64.8,F64.9,Z87.890
Gender Dysphoria Treatment15776 This surgical codes with the following DX codes: F64.0, F64.1,F64.2,F64.8,F64.9,Z87.890
Inpatient Only Code15778Impl absrb msh/prsth dly clsHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Gender Dysphoria Treatment15780 This surgical codes with the following DX codes: F64.0, F64.1,F64.2,F64.8,F64.9,Z87.890
Gender Dysphoria Treatment15781 This surgical codes with the following DX codes: F64.0, F64.1,F64.2,F64.8,F64.9,Z87.890
Gender Dysphoria Treatment15782 This surgical codes with the following DX codes: F64.0, F64.1,F64.2,F64.8,F64.9,Z87.890
Gender Dysphoria Treatment15783 This surgical codes with the following DX codes: F64.0, F64.1,F64.2,F64.8,F64.9,Z87.890
Gender Dysphoria Treatment15788 This surgical codes with the following DX codes: F64.0, F64.1,F64.2,F64.8,F64.9,Z87.890
Gender Dysphoria Treatment15789 This surgical codes with the following DX codes: F64.0, F64.1,F64.2,F64.8,F64.9,Z87.890
Gender Dysphoria Treatment15792 This surgical codes with the following DX codes: F64.0, F64.1,F64.2,F64.8,F64.9,Z87.890
Gender Dysphoria Treatment15793 This surgical codes with the following DX codes: F64.0, F64.1,F64.2,F64.8,F64.9,Z87.890
Cosmetic & Reconstructive15820Cosmetic procedures that change or improve physical appearance, without significantly improving or restoring physiological function Reconstructive procedures that either treat a medical condition or improve or restore physiologic functionPreauth required for such services whether scheduled as inpatient or outpatient.
Cosmetic & Reconstructive15821Cosmetic procedures that change or improve physical appearance, without significantly improving or restoring physiological function Reconstructive procedures that either treat a medical condition or improve or restore physiologic functionPreauth required for such services whether scheduled as inpatient or outpatient.
Cosmetic & Reconstructive15822Cosmetic procedures that change or improve physical appearance, without significantly improving or restoring physiological function Reconstructive procedures that either treat a medical condition or improve or restore physiologic functionPreauth required for such services whether scheduled as inpatient or outpatient.
Cosmetic & Reconstructive15823Cosmetic procedures that change or improve physical appearance, without significantly improving or restoring physiological function Reconstructive procedures that either treat a medical condition or improve or restore physiologic functionPreauth required for such services whether scheduled as inpatient or outpatient.
Cosmetic & Reconstructive15830Cosmetic procedures that change or improve physical appearance, without significantly improving or restoring physiological function Reconstructive procedures that either treat a medical condition or improve or restore physiologic functionPreauth required for such services whether scheduled as inpatient or outpatient.
Cosmetic & Reconstructive15847Cosmetic procedures that change or improve physical appearance, without significantly improving or restoring physiological function Reconstructive procedures that either treat a medical condition or improve or restore physiologic functionPreauth required for such services whether scheduled as inpatient or outpatient.
Cosmetic & Reconstructive15877Cosmetic procedures that change or improve physical appearance, without significantly improving or restoring physiological function Reconstructive procedures that either treat a medical condition or improve or restore physiologic functionPreauth required for such services whether scheduled as inpatient or outpatient.
Cosmetic & Reconstructive15878Cosmetic procedures that change or improve physical appearance, without significantly improving or restoring physiological function Reconstructive procedures that either treat a medical condition or improve or restore physiologic functionPreauth required for such services whether scheduled as inpatient or outpatient.
Cosmetic & Reconstructive15879Cosmetic procedures that change or improve physical appearance, without significantly improving or restoring physiological function Reconstructive procedures that either treat a medical condition or improve or restore physiologic functionPreauth required for such services whether scheduled as inpatient or outpatient.
Inpatient Only Code16036Escharotomy addl incisionHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Cosmetic & Reconstructive17106Cosmetic procedures that change or improve physical appearance, without significantly improving or restoring physiological function Reconstructive procedures that either treat a medical condition or improve or restore physiologic functionPreauth required for such services whether scheduled as inpatient or outpatient.
Cosmetic & Reconstructive17107Cosmetic procedures that change or improve physical appearance, without significantly improving or restoring physiological function Reconstructive procedures that either treat a medical condition or improve or restore physiologic functionPreauth required for such services whether scheduled as inpatient or outpatient.
Cosmetic & Reconstructive17108Cosmetic procedures that change or improve physical appearance, without significantly improving or restoring physiological function Reconstructive procedures that either treat a medical condition or improve or restore physiologic functionPreauth required for such services whether scheduled as inpatient or outpatient.
Cosmetic & Reconstructive17999Cosmetic procedures that change or improve physical appearance, without significantly improving or restoring physiological function Reconstructive procedures that either treat a medical condition or improve or restore physiologic functionPreauth required for such services whether scheduled as inpatient or outpatient.
Site of Service (SOS) - Outpatient Hospital19125Breast Lesion/Cyst/Tumor Removal Prior authorization is only required when requesting service in an outpatient hospital setting. Prior authorization is not required if performed at a participating Ambulatory Surgery Center (ASC) or in OFFICE
Gender Dysphoria Treatment19303 This surgical codes with the following DX codes: F64.0, F64.1,F64.2,F64.8,F64.9,Z87.890
Inpatient Only Code19305Mast radicalHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Inpatient Only Code19306Mast rad urban typeHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Breast Reconstruction19316Reconstruction of the breast or other than following mastectomyNotification or Prior Authorization is not required for certain diagnosis codes: Please reference the UHC Breast Recon Dx Codes TAB
Breast Reconstruction19318Reconstruction of the breast or other than following mastectomyNotification or Prior Authorization is not required for certain diagnosis codes: Please reference the UHC Breast Recon Dx Codes TAB
Breast Reconstruction19325Reconstruction of the breast or other than following mastectomyNotification or Prior Authorization is not required for certain diagnosis codes: Please reference the UHC Breast Recon Dx Codes TAB
Breast Reconstruction19328Reconstruction of the breast or other than following mastectomyNotification or Prior Authorization is not required for certain diagnosis codes: Please reference the UHC Breast Recon Dx Codes TAB
Breast Reconstruction19330Reconstruction of the breast or other than following mastectomyNotification or Prior Authorization is not required for certain diagnosis codes: Please reference the UHC Breast Recon Dx Codes TAB
Breast Reconstruction19340Reconstruction of the breast or other than following mastectomyNotification or Prior Authorization is not required for certain diagnosis codes: Please reference the UHC Breast Recon Dx Codes TAB
Breast Reconstruction19342Reconstruction of the breast or other than following mastectomyNotification or Prior Authorization is not required for certain diagnosis codes: Please reference the UHC Breast Recon Dx Codes TAB
Breast Reconstruction19350Reconstruction of the breast or other than following mastectomyNotification or Prior Authorization is not required for certain diagnosis codes: Please reference the UHC Breast Recon Dx Codes TAB
Breast Reconstruction19357Reconstruction of the breast or other than following mastectomyNotification or Prior Authorization is not required for certain diagnosis codes: Please reference the UHC Breast Recon Dx Codes TAB
Breast Reconstruction19361Reconstruction of the breast or other than following mastectomyNotification or Prior Authorization is not required for certain diagnosis codes: Please reference the UHC Breast Recon Dx Codes TAB HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Breast Reconstruction19364Reconstruction of the breast or other than following mastectomyNotification or Prior Authorization is not required for certain diagnosis codes: Please reference the UHC Breast Recon Dx Codes TAB HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Breast Reconstruction19367Reconstruction of the breast or other than following mastectomyNotification or Prior Authorization is not required for certain diagnosis codes: Please reference the UHC Breast Recon Dx Codes TAB HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Breast Reconstruction19368Reconstruction of the breast or other than following mastectomyNotification or Prior Authorization is not required for certain diagnosis codes: Please reference the UHC Breast Recon Dx Codes TAB HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Breast Reconstruction19369Reconstruction of the breast or other than following mastectomyNotification or Prior Authorization is not required for certain diagnosis codes: Please reference the UHC Breast Recon Dx Codes TAB HCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Breast Reconstruction19370Reconstruction of the breast or other than following mastectomyNotification or Prior Authorization is not required for certain diagnosis codes: Please reference the UHC Breast Recon Dx Codes TAB
Breast Reconstruction19371Reconstruction of the breast or other than following mastectomyNotification or Prior Authorization is not required for certain diagnosis codes: Please reference the UHC Breast Recon Dx Codes TAB
Breast Reconstruction19380Reconstruction of the breast or other than following mastectomyNotification or Prior Authorization is not required for certain diagnosis codes: Please reference the UHC Breast Recon Dx Codes TAB
Breast Reconstruction19396Reconstruction of the breast or other than following mastectomyNotification or Prior Authorization is not required for certain diagnosis codes: Please reference the UHC Breast Recon Dx Codes TAB
Inpatient Only Code20661Application of head braceHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Inpatient Only Code20664Application of haloHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Inpatient Only Code20802Replantation arm completeHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Inpatient Only Code20805Replant forearm completeHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Inpatient Only Code20808Replantation hand completeHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Inpatient Only Code20816Replantation digit completeHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Inpatient Only Code20824Replantation thumb completeHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Inpatient Only Code20827Replantation thumb completeHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Inpatient Only Code20838Replantation foot completeHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Spine Surgery20930  
Spine Surgery20931  
Spine Surgery20939  
Inpatient Only Code20955Fibula bone graft microvascHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Inpatient Only Code20956Iliac bone graft microvascHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Inpatient Only Code20957Mt bone graft microvascHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Inpatient Only Code20962Other bone graft microvascHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Inpatient Only Code20969Bone/skin graft microvascHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Inpatient Only Code20970Bone/skin graft iliac crestHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Bone Growth Stimulator20974Use of either electronic stimulation or ultrasound to heal fractures 
Bone Growth Stimulator20975Use of either electronic stimulation or ultrasound to heal fractures 
Bone Growth Stimulator20979Use of either electronic stimulation or ultrasound to heal fractures 
Inpatient Only Code21045Extensive jaw surgeryHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Orthognathic Surgery21120Treatment of maxillofacial (jaw) functional impairment 
Orthognathic Surgery21121Treatment of maxillofacial (jaw) functional impairment 
Orthognathic Surgery21122Treatment of maxillofacial (jaw) functional impairment 
Orthognathic Surgery21123Treatment of maxillofacial (jaw) functional impairment 
Orthognathic Surgery21125Treatment of maxillofacial (jaw) functional impairment 
Orthognathic Surgery21127Treatment of maxillofacial (jaw) functional impairment 
Orthognathic Surgery21141Treatment of maxillofacial (jaw) functional impairmentHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Orthognathic Surgery21142Treatment of maxillofacial (jaw) functional impairmentHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Orthognathic Surgery21143Treatment of maxillofacial (jaw) functional impairmentHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Orthognathic Surgery21145Treatment of maxillofacial (jaw) functional impairmentHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Orthognathic Surgery21146Treatment of maxillofacial (jaw) functional impairmentHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Orthognathic Surgery21147Treatment of maxillofacial (jaw) functional impairmentHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Orthognathic Surgery21150Treatment of maxillofacial (jaw) functional impairment 
Orthognathic Surgery21151Treatment of maxillofacial (jaw) functional impairmentHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Orthognathic Surgery21154Treatment of maxillofacial (jaw) functional impairmentHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Orthognathic Surgery21155Treatment of maxillofacial (jaw) functional impairmentHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Orthognathic Surgery21159Treatment of maxillofacial (jaw) functional impairmentHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Orthognathic Surgery21160Treatment of maxillofacial (jaw) functional impairmentHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Cosmetic & Reconstructive21172Cosmetic procedures that change or improve physical appearance, without significantly improving or restoring physiological function Reconstructive procedures that either treat a medical condition or improve or restore physiologic functionPreauth required for such services whether scheduled as inpatient or outpatient.
Cosmetic & Reconstructive21175Cosmetic procedures that change or improve physical appearance, without significantly improving or restoring physiological function Reconstructive procedures that either treat a medical condition or improve or restore physiologic functionPreauth required for such services whether scheduled as inpatient or outpatient.
Cosmetic & Reconstructive21179Cosmetic procedures that change or improve physical appearance, without significantly improving or restoring physiological function Reconstructive procedures that either treat a medical condition or improve or restore physiologic functionHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Cosmetic & Reconstructive21180Cosmetic procedures that change or improve physical appearance, without significantly improving or restoring physiological function Reconstructive procedures that either treat a medical condition or improve or restore physiologic functionHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Cosmetic & Reconstructive21181Cosmetic procedures that change or improve physical appearance, without significantly improving or restoring physiological function Reconstructive procedures that either treat a medical condition or improve or restore physiologic functionPreauth required for such services whether scheduled as inpatient or outpatient.
Cosmetic & Reconstructive21182Cosmetic procedures that change or improve physical appearance, without significantly improving or restoring physiological function Reconstructive procedures that either treat a medical condition or improve or restore physiologic functionHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Cosmetic & Reconstructive21183Cosmetic procedures that change or improve physical appearance, without significantly improving or restoring physiological function Reconstructive procedures that either treat a medical condition or improve or restore physiologic functionHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Cosmetic & Reconstructive21184Cosmetic procedures that change or improve physical appearance, without significantly improving or restoring physiological function Reconstructive procedures that either treat a medical condition or improve or restore physiologic functionHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Orthognathic Surgery21188Treatment of maxillofacial (jaw) functional impairmentHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Orthognathic Surgery21193Treatment of maxillofacial (jaw) functional impairment 
Orthognathic Surgery21194Treatment of maxillofacial (jaw) functional impairmentHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Orthognathic Surgery21195Treatment of maxillofacial (jaw) functional impairment 
Orthognathic Surgery21196Treatment of maxillofacial (jaw) functional impairmentHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Orthognathic Surgery21198Treatment of maxillofacial (jaw) functional impairment 
Orthognathic Surgery21199Treatment of maxillofacial (jaw) functional impairment 
Orthognathic Surgery21206Treatment of maxillofacial (jaw) functional impairment 
Orthognathic Surgery21210Treatment of maxillofacial (jaw) functional impairment 
Orthognathic Surgery21215Treatment of maxillofacial (jaw) functional impairment 
Cosmetic & Reconstructive21230Cosmetic procedures that change or improve physical appearance, without significantly improving or restoring physiological function Reconstructive procedures that either treat a medical condition or improve or restore physiologic functionPreauth required for such services whether scheduled as inpatient or outpatient.
Cosmetic & Reconstructive21235Cosmetic procedures that change or improve physical appearance, without significantly improving or restoring physiological function Reconstructive procedures that either treat a medical condition or improve or restore physiologic functionPreauth required for such services whether scheduled as inpatient or outpatient.
Orthognathic Surgery21240Treatment of maxillofacial (jaw) functional impairment 
Orthognathic Surgery21242Treatment of maxillofacial (jaw) functional impairment 
Orthognathic Surgery21244Treatment of maxillofacial (jaw) functional impairment 
Orthognathic Surgery21245Treatment of maxillofacial (jaw) functional impairment 
Orthognathic Surgery21246Treatment of maxillofacial (jaw) functional impairment 
Orthognathic Surgery21247Treatment of maxillofacial (jaw) functional impairmentHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Cosmetic & Reconstructive21248Cosmetic procedures that change or improve physical appearance, without significantly improving or restoring physiological function Reconstructive procedures that either treat a medical condition or improve or restore physiologic functionPreauth required for such services whether scheduled as inpatient or outpatient.
Cosmetic & Reconstructive21249Cosmetic procedures that change or improve physical appearance, without significantly improving or restoring physiological function Reconstructive procedures that either treat a medical condition or improve or restore physiologic functionPreauth required for such services whether scheduled as inpatient or outpatient.
Cosmetic & Reconstructive21255Cosmetic procedures that change or improve physical appearance, without significantly improving or restoring physiological function Reconstructive procedures that either treat a medical condition or improve or restore physiologic functionHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Cosmetic & Reconstructive21256Cosmetic procedures that change or improve physical appearance, without significantly improving or restoring physiological function Reconstructive procedures that either treat a medical condition or improve or restore physiologic functionPreauth required for such services whether scheduled as inpatient or outpatient.
Cosmetic & Reconstructive21260Cosmetic procedures that change or improve physical appearance, without significantly improving or restoring physiological function Reconstructive procedures that either treat a medical condition or improve or restore physiologic functionPreauth required for such services whether scheduled as inpatient or outpatient.
Cosmetic & Reconstructive21261Cosmetic procedures that change or improve physical appearance, without significantly improving or restoring physiological function Reconstructive procedures that either treat a medical condition or improve or restore physiologic functionPreauth required for such services whether scheduled as inpatient or outpatient.
Inpatient Only Code21632Extensive sternum surgeryHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Cosmetic & Reconstructive21263Cosmetic procedures that change or improve physical appearance, without significantly improving or restoring physiological function Reconstructive procedures that either treat a medical condition or improve or restore physiologic functionPreauth required for such services whether scheduled as inpatient or outpatient.
Cosmetic & Reconstructive21267Cosmetic procedures that change or improve physical appearance, without significantly improving or restoring physiological function Reconstructive procedures that either treat a medical condition or improve or restore physiologic functionPreauth required for such services whether scheduled as inpatient or outpatient.
Cosmetic & Reconstructive21268Cosmetic procedures that change or improve physical appearance, without significantly improving or restoring physiological function Reconstructive procedures that either treat a medical condition or improve or restore physiologic functionHCPCS Codes That Would Be Paid Only as Inpatient Procedures for CY 2023
Cosmetic & Reconstructive21275Cosmetic procedures that change or improve physical appearance, without significantly improving or restoring physiological function Reconstructive procedures that either treat a medical condition or improve or restore physiologic functionPreauth required for such services whether scheduled as inpatient or outpatient.

Last updated: Jan 1, 2023