| Code Type | Code | Description | Grouping |
|---|---|---|---|
| HCPCS | J1056 | Injection, medroxyprogesterone acetate/estradiol cypionate, 5 mg/25 mg | Other add-back |
| HCPCS | J0900 | Injection, testosterone enanthate and estradiol valerate, up to 1 cc | Other add-back |
| HCPCS | J0970 | Injection, estradiol valerate, up to 40 mg | Other add-back |
| HCPCS | J1060 | Injection, testosterone cypionate and estradiol cypionate, up to 1 mL | Other add-back |
| HCPCS | J1380 | Injection, estradiol valerate, up to 10 mg | Other add-back |
| HCPCS | J1390 | Injection, estradiol valerate, up to 20 mg | Other add-back |
| HCPCS | J1410 | Injection, estrogen conjugated, per 25 mg | Other add-back |
| HCPCS | J1435 | Injection, estrone, per 1 mg | Other add-back |
| HCPCS | J2675 | Injection, progesterone, per 50 mg | Other add-back |
| ICD-9-CM procedure | 54.11 | Exploratory laparotomy | Laparotomy |
| ICD-9-CM procedure | 54.12 | Reopening of recent laparotomy site | Laparotomy |
| ICD-9-CM procedure | 54.19 | Other laparotomy | Laparotomy |
| ICD-9-CM procedure | 54.21 | Laparoscopy; peritoneoscopy | Laparoscopy |
| ICD-9-CM procedure | 65.81 | Laparoscopic lysis of adhesions of ovary and fallopian tube | Laparoscopy |
| ICD-9-CM procedure | 65.89 | Other lysis of adhesions of ovary and fallopian tube | Laparotomy |
| ICD-9-CM procedure | 70.32 | Excision or destruction of lesion of cul-de-sac | Laparotomy |
| ICD-9-CM procedure | 57.59 | Open excision or destruction of other lesion or tissue of bladder | Laparotomy |
| ICD-9-CM procedure | 68.29 | Other excision or destruction of lesion of uterus | Laparotomy |
| ICD-9-CM procedure | 68.23 | Endometrial ablation | Other excision/ablation |
| ICD-9-CM procedure | 54.3 | Excision or destruction of lesion or tissue of abdominal wall or umbilicus | Other excision/ablation |
| ICD-9-CM procedure | 54.4 | Excision or destruction of peritoneal tissue | Other excision/ablation |
| ICD-9-CM procedure | 45.30 | Endoscopic excision or destruction of lesion of duodenum | Other excision/ablation |
| ICD-9-CM procedure | 45.31 | Other local excision of lesion of duodenum | Other excision/ablation |
| ICD-9-CM procedure | 45.32 | Other destruction of lesion of duodenum | Other excision/ablation |
| ICD-9-CM procedure | 45.33 | Local excision of lesion or tissue of small intestine, except duodenum | Other excision/ablation |
| ICD-9-CM procedure | 45.34 | Other destruction of lesion of small intestine, except duodenum | Other excision/ablation |
| ICD-9-CM procedure | 45.41 | Excision of lesion or tissue of large intestine | Other excision/ablation |
| ICD-9-CM procedure | 45.43 | Endoscopic destruction of other lesion or tissue of large intestine (Note: includes both excision and destruction by endoscopic approach) | Other excision/ablation |
| ICD-9-CM procedure | 45.49 | Other destruction of lesion of large intestine (Note: open approach) | Other excision/ablation |
| ICD-9-CM procedure | 65.25 | Other laparoscopic local excision or destruction of ovary | Other excision/ablation |
| ICD-9-CM procedure | 66.61 | Excision or destruction of lesion of fallopian tube | Other excision/ablation |
| ICD-9-CM procedure | 69.19 | Other excision or destruction of uterus and supporting structures | Other excision/ablation |
| CPT | 44200 | Laparoscopy, surgical; enterolysis (separate procedure) | Laparoscopy |
| CPT | 49321 | Laparoscopy, surgical; w/bx (single/multiple) | Laparoscopy |
| CPT | 49322 | Laparoscopy, surgical, abdomen, peritoneum and omentum; w/cavity/cyst | Laparoscopy |
| CPT | 49329 | Unlisted procedure, laparoscopy, abdomen, peritoneum and omentum | Laparoscopy |
| CPT | 56300 | Deleted 01/00 lap dx (separate procedure) | Laparoscopy |
| CPT | 56301 | Deleted 01/00 lap surg; w/fulg oviducts | Laparoscopy |
| CPT | 56302 | Deleted 01/00 lap surg; w/occlud oviducts-device | Laparoscopy |
| CPT | 56303 | Deleted 01/00 lap surg; w/fulg/exc les ovary | Laparoscopy |
| CPT | 56304 | Deleted 01/00 lap surg; w/lysis adhesions | Laparoscopy |
| CPT | 56305 | Deleted 01/00 lap surg; w/bx peritoneall surface 1/mx | Laparoscopy |
| CPT | 56306 | Deleted 01/00 lap surg; w/aspirat | Laparoscopy |
| CPT | 56309 | Deleted 01/00 lap surg; w/remov leiomyomata | Laparoscopy |
| CPT | 56310 | Deleted 01/00 laparoscopy, surgical; enterolysis (freeing of intestinal adhesion) | Laparoscopy |
| CPT | 58578 | Unlisted procedure, laparoscopy, uterus | Laparoscopy |
| CPT | 58660 | Laparoscopy, surgical; w/lysis, adhesions (salpingolysis/ovariol | Laparoscopy |
| CPT | 58661 | Laparoscopy, surgical; w/removal, adnexal structures | Laparoscopy |
| CPT | 58662 | Laparoscopy, surgical; w/fulguration/excision, lesions of ovary | Laparoscopy |
| CPT | 58670 | Laparoscopy, surgical; w/fulguration of oviducts w/wo transection | Laparoscopy |
| CPT | 58671 | Laparoscopy, surgical; w/occlusion, oviducts by device | Laparoscopy |
| CPT | 58672 | Laparoscopy, surgical; w/fimbrioplasty | Laparoscopy |
| CPT | 58673 | Laparoscopy, surgical; w/salpinostomy | Laparoscopy |
| CPT | 58679 | Unlisted procedure, laparoscopy, oviduct/ovary | Laparoscopy |
| CPT | 49320 | Laparoscopy, abdomen, peritoneum and omentum; dx w/ or w/o specimen | Laparoscopy |
| CPT | 49000 | Explor laparotomy w/wo bx (separate procedure) | Laparotomy |
| CPT | 49002 | Reopening of recent laparotomy | Laparotomy |
| CPT | 49010 | Explor retroperitoneal (separate procedure) | Laparotomy |
| CPT | 49200 | Exc intra-abd/retroperitoneal tumor | Laparotomy |
| CPT | 49201 | Exc intra-abd tumors/cysts; exten | Laparotomy |
| CPT | 58740 | Lysis adhesions | Laparotomy |
| CPT | 58805 | Drain ovarian cyst (separate procedure); ABD | Laparotomy |
| CPT | 58925 | Ovarian cystectomy unilat/bilat | Laparotomy |
| CPT | 58563 | Hysteroscopy, surgical; w/endometrial ablation | Other excision/ablation |
| CPT | 56356 | Deleted 01/00 hysteroscopy surg; w/endometr ablation | Other excision/ablation |
| CPT | 58353 | Ablation, endometrial, thermal, w/o hysteroscopic guidance | Other excision/ablation |
| CPT | 58356 | Endometrial cryoablation with ultrasonic guidance, including endometrial curettage, when performed | Other excision/ablation |
| ICD-9-CM procedure | 68.3 | Subtotal abdominal hysterectomy | Hysterectomy |
| ICD-9-CM procedure | 68.31 | Laparoscopic supracervical hysterectomy (LSH) | Hysterectomy |
| ICD-9-CM procedure | 68.39 | Other and unspecified subtotal abdominal hysterectomy | Hysterectomy |
| ICD-9-CM procedure | 68.4 | Total abdominal hysterectomy | Hysterectomy |
| ICD-9-CM procedure | 68.41 | Laparoscopic total abdominal hysterectomy | Hysterectomy |
| ICD-9-CM procedure | 68.49 | Other and unspecified total abdominal hysterectomy | Hysterectomy |
| ICD-9-CM procedure | 68.5 | Vaginal hysterectomy | Hysterectomy |
| ICD-9-CM procedure | 68.51 | Laparoscopically assisted vaginal hysterectomy (LAVH) | Hysterectomy |
| ICD-9-CM procedure | 68.59 | Other and unspecified vaginal hysterectomy | Hysterectomy |
| ICD-9-CM procedure | 68.6 | Radical abdominal hysterectomy | Hysterectomy |
| ICD-9-CM procedure | 68.61 | Laparoscopic radical abdominal hysterectomy | Hysterectomy |
| ICD-9-CM procedure | 68.69 | Other and unspecified radical abdominal hysterectomy | Hysterectomy |
| ICD-9-CM procedure | 68.7 | Radical vaginal hysterectomy | Hysterectomy |
| ICD-9-CM procedure | 68.71 | Laparoscopic radical vaginal hysterectomy (LVRH) | Hysterectomy |
| ICD-9-CM procedure | 68.79 | Other and unspecified radical vaginal hysterectomy | Hysterectomy |
| ICD-9-CM procedure | 68.8 | Pelvic evisceration | Used to exclude patients only |
| ICD-9-CM procedure | 68.9 | Other and unspecified hysterectomy | Hysterectomy |
| CPT | 51925 | Closure of vesicouterine fistula; with hysterectomy | Hysterectomy |
| CPT | 56308 | Deleted 01/00 lap surg; w/vag hyst w/wo tube(s) | Hysterectomy |
| CPT | 58150 | TAH w/wo remov tube(s) - ovary(s) | Hysterectomy |
| CPT | 58152 | TAH; w/colpo-urethrocystopexy | Hysterectomy |
| CPT | 58180 | Supracerv ABD hyst w/wo remov tube | Hysterectomy |
| CPT | 58200 | TAH w/part vaginect w/lymph node | Hysterectomy |
| CPT | 58210 | Rad ABD hyst w/tot pelvic lymphaden | Used to exclude patients only |
| CPT | 58240 | Pelvic exenteration-gyn malig w/TAH | Used to exclude patients only |
| CPT | 58260 | Vag hyst | Hysterectomy |
| CPT | 58262 | Vag hyst; w/remov tube and/or ovary | Hysterectomy |
| CPT | 58263 | Vag hyst; tube/ovary w/repr enteroc | Hysterectomy |
| CPT | 58267 | Vag hyst; w/colpo-urethrocystopexy | Hysterectomy |
| CPT | 58270 | Vag hyst; w/repr enterocele | Hysterectomy |
| CPT | 58275 | Vag hyst w/tot/part colpectomy | Hysterectomy |
| CPT | 58280 | Vag hyst w/colpect; w/repr enteroce | Hysterectomy |
| CPT | 58285 | Vag hyst radical | Hysterectomy |
| CPT | 58290 | Vaginal hysterectomy, for uterus greater than 250 g | Hysterectomy |
| CPT | 58291 | Vaginal hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or | Hysterectomy |
| ovary(s) | |||
| CPT | 58292 | Vaginal hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s), with repair of enterocele | Hysterectomy |
| CPT | 58293 | Vaginal hysterectomy, for uterus greater than 250 g; with colpo-urethrocystopexy (Marshall-Marchetti-Krantz type, pereyra type) with or without endoscopic control | Hysterectomy |
| CPT | 58294 | Vaginal hysterectomy, for uterus greater than 250 g; with repair of enterocele | Hysterectomy |
| CPT | 58541 | Laparoscopy, surgical, supracervical hysterectomy, for uterus 250 g or less | Hysterectomy |
| CPT | 58542 | Laparoscopy, surgical, supracervical hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s) | Hysterectomy |
| CPT | 58543 | Laparoscopy, surgical, supracervical hysterectomy, for uterus greater than 250 g | Hysterectomy |
| CPT | 58544 | Laparoscopy, surgical, supracervical hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s) | Hysterectomy |
| CPT | 58548 | Laparoscopy, surgical, with radical hysterectomy, with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling (biopsy), with removal of tube(s) and ovary(s), if performed | Hysterectomy |
| CPT | 58550 | Laparoscopy, surgical; w/ vaginal hysterectomy w/wo removal ovary | Hysterectomy |
| CPT | 58552 | Laparoscopy, surgical, with vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s) | Hysterectomy |
| CPT | 58553 | Laparoscopy, surgical, with vaginal hysterectomy, for uterus greater than 250 g | Hysterectomy |
| CPT | 58554 | Laparoscopy, surgical, with vaginal hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s) | Hysterectomy |
| CPT | 58570 | Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less | Hysterectomy |
| CPT | 58571 | Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s) | Hysterectomy |
| CPT | 58572 | Laparoscopy, surgical, with total hysterectomy, for uterus greater than 250 g | Hysterectomy |
| CPT | 58573 | Laparoscopy, surgical, with total hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s) | Hysterectomy |
| CPT | 59135 | Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy | Hysterectomy |
| CPT | 59136 | Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy with partial resection of uterus | Hysterectomy |
| CPT | S2078 | Laparoscopic supracervical hysterectomy (subtotal hysterectomy), with or without removal of tube(s), with or without removal of ovary(s) | Hysterectomy |
| CPT | 58953 | Bilat salpingo-oophorect w/omentect, total abdom | Hysterectomy |
| CPT | 58954 | Bilat salping-oophorec w/omentec, tl abdom hyst & lymphadenectomy | Hysterectomy |
| CPT | 58956 | Bilateral salpingo-oophorectomy with total omentectomy, total abdominal hysterectomy for malignancy | Hysterectomy |
| ICD-9-CM procedure | 65.3 | Unilateral oophorectomy | Oophorectomy |
| ICD-9-CM procedure | 65.31 | Laparoscopic unilateral oophorectomy | Oophorectomy |
| ICD-9-CM procedure | 65.39 | Other unilateral oophorectomy | Oophorectomy |
| ICD-9-CM procedure | 65.4 | Unilateral salpingo-oophorectomy | Oophorectomy |
| ICD-9-CM procedure | 65.41 | Laparoscopic unilateral salpingo-oophorectomy | Oophorectomy |
| ICD-9-CM procedure | 65.49 | Other unilateral salpingo-oophorectomy | Oophorectomy |
| ICD-9-CM procedure | 65.5 | Bilateral oophorectomy | Oophorectomy |
| ICD-9-CM procedure | 65.51 | Other removal of both ovaries at same operative episode | Oophorectomy |
| ICD-9-CM procedure | 65.52 | Other removal of remaining ovary | Oophorectomy |
| ICD-9-CM procedure | 65.53 | Laparoscopic removal of both ovaries at same operative episode | Oophorectomy |
| ICD-9-CM procedure | 65.54 | Laparoscopic removal of remaining ovary | Oophorectomy |
| ICD-9-CM procedure | 65.6 | Bilateral salpingo-oophorectomy | Oophorectomy |
| ICD-9-CM procedure | 65.61 | Other removal of both ovaries and tubes at same operative episode | Oophorectomy |
| ICD-9-CM procedure | 65.62 | Other removal of remaining ovary and tube | Oophorectomy |
| ICD-9-CM procedure | 65.63 | Laparoscopic removal of both ovaries and tubes at same operative episode | Oophorectomy |
| ICD-9-CM procedure | 65.64 | Laparoscopic removal of remaining ovary and tube | Oophorectomy |
| CPT | 58940 | Oophorectomy part/tot unilat/bilat | Oophorectomy |
| CPT | 58943 | Oophorectomy; ovarian malig w/bx | Oophorectomy |
CPT = Current Procedural Terminology; HCPCS = Healthcare Common Procedure Coding System; ICD-9-CM = International Classification of Diseases, Ninth Revision, Clinical Modification.