{"text_format":"1","workbook":"xlsx","n_sheets":1,"sheets":["HFS FPP Service Codes"],"not_rendered":{"charts":0,"images":0,"macros":0,"external_links":0,"defined_names":1,"comments":0,"pivot_tables":0},"unopened":[],"bounds":{"document_bytes":16777216,"sheet_cells":100000,"rows_first":2000,"rows_last":500,"rows_between":2000,"halvings":0,"cell_chars":16384,"cell_head_chars":4096},"cells_cut":0,"cells_raw":0,"read":"whole","date_system":"1900"}

{"sheet":"HFS FPP Service Codes","index":0,"n_rows":293,"n_cols":8,"rows_kept":293,"cut":false,"hidden":false,"merged":[[0,0,0,3],[0,5,0,9],[1,5,1,9],[2,5,2,9],[1,0,4,3],[4,5,4,9],[3,5,3,9],[6,5,7,9],[8,5,8,6],[9,5,9,6],[8,7,8,9],[9,7,9,9]]}
["ICAN! HFS Family Planning Program and Family Planning Presumptive Eligibility (FPPE) Covered Services Guide",null,null,null,null,"Helpful Links"]
["The below description of services are intended to serve as a guide to interpret the latest HFS fee schedule for the HFS Family Planning Program and FPPE. This guide was independently developed by ICAN! and has not been reviewed or approved by HFS. If you have feedback or questions on the guide, please contact ican4all@alliancechicago.org.",null,null,null,null,"HFS Family Planning Program Fee Schedule"]
[null,null,null,null,null,"HFS info page on HFS FPP/FPPE"]
[null,null,null,null,null,"HFS FPPE/MPE Provider Page"]
[null,null,null,null,null,"ICAN! HFS FPP info page"]
["Procedure Code","Coverage Effective Date","Family Planning Diagnosis Required?","Description of Service"]
["00851","2022-11-30","N","00851 - Anesthesia, for procedures of the lower abdomen",null,"Helpful HFS Phone Numbers"]
["00952","2022-11-30","N","00952 - Anesthesia, procedures for the perineum"]
["01965","2022-11-30","N","01965 - Intrathecal/epidural catheter insertion, anesthesia for obstetric procedure",null,"Enrollment questions:",null,"877-805-5312"]
["01966","2022-11-30","N","01966 - Anesthesia services for induced abortion procedure",null,"Billing questions:",null,"217-782-5565"]
["11976","2022-11-30","N","11976 - Removal of implantable contraceptive capspules or pellets"]
["11981","2022-11-30","N","11981 - Insertion, non-biodegradable drug implant"]
["11982","2022-11-30","N","11982 - Removal, non-biodegradable drug implant"]
["11983","2022-11-30","N","11983 - Removal and reinsertion of  non-biodegradable drug implant"]
["17000","2022-11-30","Y","17000 - Destruction, premalignant lesions"]
["49320","2022-11-30","Y","49320 - Laparoscopic abdominal diagnostic procedure"]
["55250","2022-11-30","N","55250 - Unilateral or bilateral vasectomy including post op semen exam"]
["56420","2022-11-30","Y","56420 - Bartholin's gland, incision and drainage"]
["56501","2022-11-30","N","56501 -Destruction of lesion(s) Vulva or perineum (simple)"]
["56515","2022-11-30","N","56515 - Destruction of lesion(s), Vulva or perineum lesion destruction (extensive)"]
["57061","2022-11-30","N","57061 - Destruction of small or simple vaginal lesions"]
["57065","2022-11-30","N","57065 - Destruction of multiple vaginal growths/lesions"]
["57160","2022-11-30","Y","57160 - Fitting and insertion of a pessary or other intravaginal support device"]
["57170","2022-11-30","N","57170 - Fitting for diaphragm or cervical cap"]
["57410","2022-11-30","Y","57410 - Pelvic examination done under anesthesia"]
["57452","2022-11-30","Y","57452 - Colposcopy of the cervix including upper/ adjacent vagina"]
["57454","2022-11-30","Y","57454 - Colposcopy of the cervix including upper/adjacent vaigna with biopsy of the cervix and endocervical curettage"]
["57455","2022-11-30","Y","57455 - Colposcopy of the cervix including upper/adjacent vagina with biopsy(s) of the cervix"]
["57456","2022-11-30","Y","57456 - Colposcopy of the cervix with endocervical curettage"]
["57460","2022-11-30","Y","57460 - Colposcopy of the cervix with loop electrode biopsy(s) of the cervix (LEEP)"]
["57461","2022-11-30","Y","57461 - Colposcopy of the cervix including upper/adjacent vagina with loop electrode conization of the cervix (LEEP)"]
["57500","2022-11-30","Y","57500 - Removal of a lesion such as a polyp on the cervix or performs biopsy(s) of the cervix with or without high frequency electric current (fulguration)"]
["57505","2022-11-30","Y","57505 - Endocervical curettage to collect tissue samples with a curette, not part of D&C procedure"]
["57510","2022-11-30","Y","57510 - Excision procedures on the cervix uteri using electric current or thermal cautery to destroy cervical lesions"]
["57511","2022-11-30","Y","57511 - Excision procedures on the cervix/freezing destruction of the cervix"]
["57522","2022-11-30","Y","57522 - Conization of the cervix  without using a colposcope"]
["58100","2022-11-30","Y","58100 - Endometrial biopsy without dilating the cervix"]
["58110","2022-11-30","Y","58110 - Endometrial sampling or biopsy performed during a colposcopy"]
["58300","2022-11-30","N","58300 - Insertion of an intrauertine deivce (IUD)"]
["58301","2022-11-30","N","58301 - Removal of an intrauterine device (IUD)"]
["58340","2022-11-30","Y","58340 - Catheterization and introduction of substances for selective fallopian tube catheterization, including imaging supervision and interpretation"]
["58555","2022-11-30","Y","58555 - Diagnostic hysteroscopy to examine uterine cavity"]
["58565","2022-11-30","N","58565 - Laparoscopic/hysteroscopic procedure with bilateral fallopian tube cannulation to induce occulsion by placement of permanent implants"]
["58600","2022-11-30","N","58600 - Ligation or transection of fallopian tube(s), abdominal or vaginal approach"]
["58605","2022-11-30","N","58605 - Ligation or transection of fallopian tube(s), abdominal or vaginal approach, postpartum during same hospitalization as delivery"]
["58611","2022-11-30","N","58611 - Ligation or transection of fallopain tube(s) done at time of cesarean delivery or intra-abdominal surgery"]
["58615","2022-11-30","N","58615 - Occlusion of fallopian tube by device (band, clip or ring)  at cesarean delivery or intra-abdominal surgery. "]
["58661","2022-11-30","N","58661 - Laparoscopic surgical with removal of adnexal (partial or total oopherectomy and /or salpingectomy)"]
["58670","2022-11-30","N","58670 - Laparoscopic surgical; with fulguration or excision of lesions of the ovary, pelvic viscera, or peritoneal surface by any method"]
["58671","2022-11-30","N","58671 - Laparoscopic surgical; with removal of adnexal structures (partial or total oophorectomy and/or salpingectomy) "]
["58673","2022-11-30","Y","58673 - Laparoscopic surgical procedures involving the creation of a new opening at the end of the fallopian tube, used for unilateral procedures only. "]
["58700","2022-11-30","Y","58700 - Salpingo-oophorectomy, complete or partial, unilateral or bilateral (separate procedure)"]
["59812","2022-11-30","N","59812 - Surgical management of an incomplete abortion, used to report the D&C"]
["59820","2022-11-30","Y","59820 - Treatment of a missed abortion, surgically, first trimester"]
["59821","2022-11-30","N","59821 - Treament of a missed abortion, surgically second trimester"]
["59830","2022-11-30","Y","59830 - Surgical treatment of septic abortion, removing POC"]
["59840","2022-11-30","Y","59840 - Abortion procedure by dilation and curettage (D&C)"]
["59841","2022-11-30","Y","59841 - Induced abortion by dilation and evacuation"]
["59850","2022-11-30","Y","59850 - Induced abortion using one or more intra-amniotic injections to cause fetal demise and intiatie labor process"]
["59851","2022-11-30","Y","59851 - Induced abortion using one or more intra-amniotic injections, typicall >14 wks, includes hospital admission"]
["59855","2022-11-30","Y","59855 - Induced abortion by one or more vaginal suppositories with or w/o cervical dilation"]
["74018","2022-11-30","Y","74018 - X-ray examination of abdomen with one view"]
["74740","2022-11-30","Y","74740 - Hysterosalpingography, x-ray procedure to evaluate the uterus and fallopian tubes with  selective contrast catheterization of fallopian tube(s)"]
["76376","2022-11-30","Y","76376 - 3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality with image postprocessing under concurrent supervision"]
["76830","2022-11-30","Y","76830 - Ultrasound, transvaginal"]
["76856","2022-11-30","Y","76856 - Ultrasound, complete evaluation of the  pelvic structures (nonobstetric), real-time with image documentation; limited"]
["76857","2022-11-30","Y","76857 - Ultrasound, pelvic (nonobstetric), limited to assess one or more pelvic organs (bladder, uterus, ovaries, or prostate)"]
["76998","2022-11-30","Y","76998 - Ultrasound guidance, intraoperative"]
["77065","2022-11-30","Y","77065 - Diagnostic mammography code for unilateral breast imaging, including computer aided detection (CAD)"]
["77066","2022-11-30","Y","77066 - Diagnostic mammography code used for bilateral breast imaging, including computer aided detection (CAD)"]
["77067","2022-11-30","Y","77067 - Screening mammogram for both breasts  including computer aided detection (CAD)"]
["80061","2022-11-30","Y","80061 - Lipid panel"]
["81000","2022-11-30","Y","81000 - Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; automated, with microscopy"]
["81001","2022-11-30","Y","81001 - Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; automated, with microscopy"]
["81002","2022-11-30","Y","81002 - Urinalysis, non-automated without microscopy ( dipstick)"]
["81003","2022-11-30","N","81003 - Urinanalysis, automated without microscopy"]
["81005","2022-11-30","Y","81005 - Urinalysis, qualitative or semi-quantitative, except immunoassays"]
["81007","2022-11-30","Y","81007 - Urinalysis, bacteriruria screen, by non-culture, commercial ki"]
["81015","2022-11-30","Y","81015 - Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; reagent strip, microscopic only"]
["81025","2022-11-30","Y","81025 - Urine pregnancy test, by visual color comparison methods"]
[81162,"2022-11-30","Y","81162 - Genetic analysis of the BRCA1 and BRCA2 genes, covers full sequence analysis and full duplication/deletion of both genes."]
["82270","2022-11-30","Y","82270 - Blood occult test, feces, 1-3 simultaneous determinations, qualitative test that indicates presence of blood in stool (FIT or FOBT)"]
["82947","2022-11-30","Y","82947 - Glucose; quantitative, blood (except reagent strip)"]
["83020","2022-11-30","Y","83020 - Hemoglobin fractionation and quantitation"]
["83021","2022-11-30","Y","83021 - Hemoglobin; electrophoresis or hgb identification, also use to identify thalassemia anemia"]
["83026","2022-11-30","Y","83026 - Hemoglobin; glycosylated (A1c)"]
["83036","2022-11-30","Y","83036 - Hemoglobin A1c lab test use dto measure and monitor blood sugar levels"]
["84144","2022-11-30","Y","84144 - Procedural code for measuring the level of progesterone, a reproductive hormone"]
["84146","2022-11-30","Y","84146 - Prolactin level testing useful for detecting prolactin secreting pituatary tumors and other conditions that affect the hypothalamus or pituitary gland."]
["84402","2022-11-30","Y","84402 - Testosterone, free (direct), serum"]
["84403","2022-11-30","Y","84403 - Testosterone; total levels, serum"]
["84702","2022-11-30","Y","84702 - Human chorionic gonadotropin (HCG), quantitative measurement, serum"]
["84703","2022-11-30","Y","84703 - Human chorionic gonadotropin (HCG), b-subunite, qualitative, serum"]
["85013","2022-11-30","Y","85013 - Complete (CBC), automated (Hgb, Hct, RBC, WBC, and platelet count)"]
["85014","2022-11-30","Y","85014 - Complete (CBC), automated (Hgb, Hct, RBC, WBC, and platelet coumt), red blood cell concentration measurement"]
["85018","2022-11-30","Y","85018 - Hemoglobin levels in a whole blood sample"]
["85025","2022-11-30","Y","85025 - Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC, and platelet count)"]
[85027,"2022-11-30","Y","85027 - Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC, and platelet count); CBC without a differential "]
["86592","2022-11-30","Y","86592 - Syphilis test, non-treponemal antibody; qualitative (eg, VDRL, RPR, ART)"]
["86593","2022-11-30","Y","86593 - Syphilis test, non-treponemal antibody; quantitative"]
["86628","2022-11-30","Y","86628 - Qualitative or semiquantitative immunoassays for analysis for antibody to candida (yeast)"]
["86631","2022-11-30","Y","86631 - Antibody; Chlamydia trachomatis"]
["86632","2022-11-30","Y","86632 - Antibody IgM; Chlamydia trachomatis, with reflex to confirmation, serum"]
["86689","2022-11-30","Y","86689 - Antibody; HTLV or HIV antibody, confirmatory test ( Western Blot)"]
["86694","2022-11-30","Y","86694 - Antibodies to non specific type of herpes simplex virus (HSV), serum"]
["86695","2022-11-30","Y","86695 - Antibody, qualitative or semiquantitative immunoassays, testing for HSV1 or IgG antibodies"]
["86696","2022-11-30","Y","86696 - Antibodies to type 2 herpes simplex ( HSV-2), immunoassays procedure, serum or CSF"]
["86701","2022-11-30","Y","86701 - Antibody HIV-1 test"]
["86702","2022-11-30","Y","86702 - Antibodies to HIV-2, serum"]
["86703","2022-11-30","Y","86703 - Antibody to HIV-1 and HIV-2 virus"]
["86780","2022-11-30","Y","86780 - Antibody to treponema pallidum (bacterium that causes syphilis)"]
["86787","2022-11-30","Y","86787 - Antibodies to varicella -zoster (chickenpox and shingles), serum or CSF"]
["87086","2022-11-30","Y","87086 - Bacterial culture, urine; quantitative colony count, urine"]
["87088","2022-11-30","Y","87088 - Bacterial culture, urine; with isolation and presumptive identification of non-urinary pathogens including antimicrobial sensitivity when performed"]
["87110","2022-11-30","Y","87110 - Culture, typing; Chlamydia"]
["87184","2022-11-30","Y","87184 - Suspectibility studies by disk metho or urine culture isolates, 12 or fewer agents"]
["87186","2022-11-30","Y","87186 - Suspectiblity studies by the MIC (minimum inhibitory concentration) technique on urine culture isolates for sensitivity studies"]
["87210","2022-11-30","Y","87210 - Smear, wet mount for infectious agents ( bacteria, fungi, or cell types)"]
["87270","2022-11-30","Y","87270 - Infectious agent antigen detection by immunofluorescent technique, Chlamydia trachomatis"]
["87273","2022-11-30","Y","87273 - Infeciout agent antigen detection by immunofluorescent technique for Herpes Simples Virus 2 ( HSV 2, genital herpes)"]
["87285","2022-11-30","Y","87285 - lab analyst to detect antigens of Treponema pallidum bacteria using immunofluorescent antibody stain and fluorescence microscopy"]
["87320","2022-11-30","Y","87320 - Infectious agent antigen detection by enzyme immunoassay technique for Chlamydia"]
["87390","2022-11-30","Y","87390 - Infectious agent antigen detection of HIV-1  by enzyme immunoassay without the inclusion of HIV-2 antibodies"]
["87391","2022-11-30","Y","87391 - Infectious agent antigen detection of HIV-2  by enzyme immunoassay techniqe"]
["87485","2022-11-30","Y","87485 - Infectious agent detection by nucleic acid (DNA or RNA) with direct probe technique to detect the presence of chlamydia pneumoniae"]
["87490","2022-11-30","Y","87490 - Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, amplified probe technique"]
["87491","2022-11-30","Y","87491 - Infectious agent detection by nucleic acid amplification techniques (DNA or RNA); Chlamydia trachomatis, quantification"]
["87492","2022-11-30","Y","87492 - Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, quantification"]
["87510","2022-11-30","Y","87510 - Laboratory test to detect the presence of Gardnerella vaginalis with direct nucleic acid probe technique"]
["87511","2022-11-30","Y","87511 - Amplified nucleic acid probe technique to identify the presence of Gardnerella vaginalis"]
["87512","2022-11-30","Y","87512 - Detection of Gardnerella vaginalis, a bacteria associated with bacterial vaginosis; quantification using nucleic acid probe technique"]
["87528","2022-11-30","Y","87528 - Infectious agent detection by nucleic acid (DNA or RNA); amplified probe technique, Herpes simplex virus ( HSV)"]
["87529","2022-11-30","Y","87529 - Infectious agent detection by nucleic acid (DNA or RNA); amplified probe technique, differentiates HSV-1 and HSV-2"]
["87530","2022-11-30","Y","87530 - Infectious agent detection by nucleic acid (DNA  sequences by PCR); quantification, amplified probe technique,  HSV-1 and HSV-2"]
["87590","2022-11-30","Y","87590 - Infectious agent detection by nucleic acid (DNA or RNA); detection test for Neisseria gonorrhoeae"]
["87591","2022-11-30","Y","87591 - Infectious agent detection by nucleic acid (DNA or RNA); Neisseria gonorrhae amplified probe technique"]
["87592","2022-11-30","Y","87592 - Infectious agent detection by nucleic acid (DNA or RNA); Neisseria gonorrhoeae quantification"]
[87623,"2022-11-30","Y","87623 - Infectious agent detection by nucleic acid (DNA or RNA); specifically for detecting low risk types of Human Papillomavirus (HPV) such as 6, 11, 43, 43, and 44"]
[87624,"2022-11-30","Y","87624 - Infectious agent detection by nucleic acid (DNA or RNA); detection of high risk types of Human Papillomavirus (HPV), causative agent of cervical dysplasia and carcinoma. "]
[87625,"2022-11-30","Y","87625 - Infectious agent detection by nucleic acid (DNA or RNA); HPV types 16, 18, and 45"]
["87660","2022-11-30","Y","87660 - Direct probe technique used to detect the presence of Trichomonas vaginalis, a protozoan parasite in a primary specimen"]
["87808","2022-11-30","Y","87808 - Infectious agent antigen detection of Trichomonas vaginalis  by immunoassay with direct optical observation"]
["87810","2022-11-30","Y","87810 - Infectious agent antigen detection by immunoassay with direct optical observation; Chlamydia trachomatis"]
["87850","2022-11-30","Y","87850 - Infectious agent antigen detection by immunoassay with direct optical observation; Neisseria gonorrhea"]
["87899","2022-11-30","Y","87899 - Infectious agent antigen detection by immunoassay with direct optical observation; multiple step method and specific infectious organism is NOT identified by another code"]
["88141","2022-11-30","Y","88141 - Cytopathology, in situ hybridization (eg, FISH), cervical or vaginal (any reporting system), usually through a pap smear or liquid based cytology"]
["88142","2022-11-30","Y","88142 - Cytopathology, in situ hybridization (eg, FISH), cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, manual screening under physician supervision"]
["88143","2022-11-30","Y","88143 - Cytopathology, in situ hybridization (eg, FISH), manual screening and rescreening under physician supervision , used for liquid based specimens."]
["88147","2022-11-30","Y","88147 - Cytopathology smears, cervical or vaginal using an automated system under physician supervision. Code is for one screening session"]
["88148","2022-11-30","Y","88148 - Cytopathology smears, cervical or vaginal, screened by automated system with manual rescreenign under physician supervision"]
["88150","2022-11-30","Y","88150 - Cytopathology screening procedure ,cervical or vaginal,  manually under a physician's supervision"]
["88152","2022-11-30","Y","88152 - Cytopathology, selective cellular enhancement technique/computer-assisted rescreening,  with interpretation and report (eg, liquid based slide preparation method)"]
["88153","2022-11-30","Y","88153 - Cytopathology,  cervical/vaginal pap smear, selective cellular enhancement technique with manual screening and rescreening under physician supervision "]
["88155","2022-11-30","Y","88155 - Cytopathology screening procedures, used to report physician interpreation of a cervicla or vaginal specimen. "]
["88160","2022-11-30","Y","88160 - Cytopathology smears , lab analyste performs the technical steps to analyze a cytopathology specimen smeared on a slide. "]
["88161","2022-11-30","Y","88161 - Pathology and laboratory cytopathology screening exam of specimen cells. Can be used for tumor immunohistochemistry."]
["88162","2022-11-30","Y","88162 - Cytopathology smears with extended study, analyzing over 5 slides or multiple stains"]
["88164","2022-11-30","Y","88164 - Cytopathology, manual screening of cervical or vaginal slide by a lab analyst under the supervision of a physician."]
["88165","2022-11-30","Y","88165 - Cytopathology, slides, cervical or vaginal; manual screening with rescreening under physician supervision"]
["88166","2022-11-30","Y","88166 - Cytopathology, slides, cervical or vaginal; with manual screening and rescreening by computer assisted system under physician supervision"]
["88167","2022-11-30","Y","88167 - Cytopathology, slides, cervical or vaginal; with manual screening by automated system under physician supervision using the Bethesda System"]
["88174","2022-11-30","Y","88174 - Cytopathology, preservative fluid, cervical or vaginal; screening by automated system, with further review by physician"]
["88175","2022-11-30","Y","88175 - Cytopathology, preservative fluid, cervical or vaginal; with automated thin layer preparation, followed by  screening  with automated system and manual rescreening under physician supervision. Bethesda or non-Bethesda reporting system"]
["88305","2022-11-30","Y","88305 - Surgical pathology, gross and microscopic examination ( code endometrial curettings, biopsies and polyps for gynecological specimens"]
["88307","2022-11-30","Y","88307 - Surgical pathology, gross and microscopic examination of tissue with moderately high complexiity.  Applied to ovary with or w/o tube, neoplastic, or excision of lesion requiring microscopic evaluation of surgical margins."]
["88331","2022-11-30","Y","88331 - First block of the frozen section specimen- surgical pathology examination)"]
["88332","2022-11-30","Y","88332 - Pathology consultation during surgery, each additional tissue block with frozen section. "]
["89300","2022-11-30","N","89300 - Semen analysis for presence and/or motility of sperm and a Huhner test"]
[89310,"2022-11-30","N","89310 - Semen analysis procedure to analyze semen for motility and count"]
["89321","2022-11-30","N","89321 - Semen analysis including the presence and motility of sperm, use for post-vasectomy"]
[90651,"2022-11-30","Y","90651 -Human Papillomavirus (HPV) vaccine, types 16, 18, bivalent (2vHPV), 3 dose schedule, for intramuscular use. This vaccine is typically administered to prevent HPV infection, which can lead to cervical cancer, genital warts, and other cancers."]
["90744","2022-11-30","Y","90744 - Hepatitis B vaccine, adolescent or pediatric dosage (3 dose schedule), for intramuscular use."]
["99070","2022-11-30","Y","99070 - Supplies and materials (except spectacles), provided by the physician over and above those usually included with the office visit or other services rendered."]
[99152,"2022-11-30","Y","99152 - Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer."]
["99202","2022-11-30","Y","99202 - Office or other outpatient visit for the evaluation and management  (E/M) of a new patient with straightforward medical decision making and/or  11-20 minutes of patient encounter time"]
["99203","2022-11-30","Y","99203 - Office or other outpatient visit for the evaluation and management (E/M) of a new patient,low medical deicison making and/or 30 to 44 minutes"]
["99204","2022-11-30","Y","99204 - Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity,  45-59 minutes."]
["99205","2022-11-30","Y","99205 - Office or other outpatient visit for the evaluation and management of a new patient, comprehensive, high complexity, 60-74 minutes"]
["99211","2022-11-30","Y","99211 - Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician."]
["99212","2022-11-30","Y","99212 - Office or other outpatient visit for the evaluation and management of an established patient, straightforward, typically last 10-19 minutes"]
[99213,"2022-11-30","Y","99213 - Office or other outpatient visit for the evaluation and management of an established patient, low complexity, 20-29 minutes"]
[99214,"2022-11-30","Y","99214 - Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity, 30-39 minutes"]
["99215","2022-11-30","Y","99215 - Office or other outpatient visit for the evaluation and management of an established patient, comprehensive, high complexity, 40+ minutes"]
["99221","2022-11-30","Y","99221 - Initial hospital care, low complexity."]
["99222","2022-11-30","Y","99222 - Initial hospital care, moderate complexity."]
["99223","2022-11-30","Y","99223 - Initial hospital care, high complexity."]
[99231,"2022-11-30","Y","99231 - Subsequent hospital care, minimal."]
["99232","2022-11-30","Y","99232 - Subsequent hospital care, low complexity."]
["99233","2022-11-30","Y","99233 - Subsequent hospital care, moderate complexity."]
["99238","2022-11-30","Y","99238 - Hospital discharge day management; 30 minutes or less."]
["99239","2022-11-30","Y","99239 - Hospital discharge day management; more than 30 minutes."]
["99242","2022-11-30","Y","99242 - Office consultation for a new or established patient, low complexity."]
["99243","2022-11-30","Y","99243 - Office consultation for a new or established patient, moderate complexity."]
["99244","2022-11-30","Y","99244 - Office consultation for a new or established patient, high complexity."]
["99245","2022-11-30","Y","99245 - Office consultation for a new or established patient, comprehensive."]
["99252","2022-11-30","Y","99252 - Prolonged service in the office or other outpatient setting, requiring direct patient contact beyond the usual service, first hour."]
["99253","2022-11-30","Y","99253 - Prolonged service in the office or other outpatient setting, requiring direct patient contact beyond the usual service, first hour."]
["99254","2022-11-30","Y","99254 - Prolonged service in the office or other outpatient setting, requiring direct patient contact beyond the usual service, each additional 30 minutes."]
["99255","2022-11-30","Y","99255 - Prolonged service in the office or other outpatient setting, requiring direct patient contact beyond the usual service, each additional 30 minutes."]
["99383","2022-11-30","Y","99383 - Initial preventive visit, new patient, age 5-11 years"]
["99384","2022-11-30","Y","99384 - Initial preventive visit, new patient, age 12-17 years"]
["99385","2022-11-30","Y","99385 - Initial preventive visit, new patient, age 18-39 years"]
["99386","2022-11-30","Y","99386 - Initial preventive visit, new patient, 40-64 years"]
["99393","2022-11-30","Y","99393 - Periodic comprehensive preventive medicine reevaluation and management, 5-11 years"]
["99394","2022-11-30","Y","99394 - Periodic comprehensive preventive medicine reevaluation  and management, 12-17 years"]
["99395","2022-11-30","Y","99395 - Periodic comprehensive preventive medicine reevaluation and management, 18-39 years"]
["99396","2022-11-30","Y","99396 - Periodic comprehensive preventive medicine reevaluation and management, 40-64 years"]
["999401","2022-11-30","Y","99401 - Preventive medicine counseling and/or risk factor reduction; approximately 15 minutes."]
["A4267","2022-11-30","Y","A4267 - Contraceptive supply, condom, male, each"]
["A4268","2022-11-30","N","A4268 -Contraceptive supply, condom, female, each"]
["A4269","2022-11-30","N","A4269 - Contraceptive supply spermicide (foam, gel), each"]
["G0101","2022-11-30","N","G0101 - Cervical or vaginal cancer screening; pelvic and clinical breast examination."]
["G0123","2022-11-30","Y","G0123 - Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; screening by cytotechnologist under physician supervision."]
["G0124","2022-11-30","Y","G0124 - Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; manual screening under physician supervision."]
["G0279","2022-11-30","Y","G0279 - Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066)"]
["G0432","2022-11-30","Y","G0432 - Infectious agent antibody detection by enzyme immune assay (EIA) technique, qualitative or semi quantitative, multiple step method, HIV-1 or HIV-2 screening"]
["G0433","2022-11-30","Y","G0433 - Infectious agent antibody by enzyme linked immunosorbent assay ( ELISA) technique , HIV-1 and/or HIV-2"]
["G0435","2022-11-30","Y","G0435 - Infectious agent antibody detection by rapid antibody test, HIV-1 and/or HIV-2 screening or just \"oral HIV-1/HIV-2 screen\""]
["G0475","2022-11-30","Y","G0475 - HIV antigen/antbiody combination assay screening"]
["J0694","2022-11-30","N","J0694 - Injection, Cefuroxime sodium, 1 gm"]
["J0696","2022-11-30","N","J0696 - Injection, Ceftriaxone sodium, per 250 mg"]
["J0698","2022-11-30","N","J0698 - Injection, Ceftriaxone sodium"]
["J1050","2022-11-30","N","J1050 - Injection, Medroxyprogesterone acetate, 1 mg"]
["J3490","2022-11-30","N","J3490 - Unspecified drug, injection(must bill with NDC numbers, drug name/dosage/route (EC Pills)"]
["J7294","2022-11-30","N","J7294 - Segesterone acetate and ethinyl estradiol per 24  hours, yearly vaginal  system each (Annovera)"]
["J7295","2022-11-30","N","J7295 - Ethinyl estradiol and etonogestrel per 24 hours, monthly vagina ring, each (Eluryng/Nuvaring)"]
["J7296","2022-11-30","N","J7296 - Levonorgestrel-releasing intrauterine contraceptive system, 19.5 mg (Kyleena)"]
["J7297","2022-11-30","N","J7297 - Levonorgestrel-releasing intrauterine contraceptive system, 52 mg (Liletta)"]
["J7298","2022-11-30","N","J7298 - Levonorgestrel-releasing intrauterine contraceptive system, 52 mg (Mirena)"]
["J7300","2022-11-30","N","J7300 - Intrauterine copper contraceptive (Paragard)"]
["J7301","2022-11-30","N","J7301 - Levonorgestrel-releasing intrauterine contraceptive system, 13.5 mg  (Skyla)"]
["J7304","2022-11-30","N","J7304 - Contraceptive supply, hormone containing patch, each (Xuland, Zafemy, Twirla)"]
["J7307","2022-11-30","N","J7307 - Etonogestrel contraceptive implant system, including implant and supplies (Nexplanon)"]
["J8499","2022-11-30","N","J8499 - Prescription drug, oral, non-chemotherapeutic, NOS."]
["Q0111","2022-11-30","Y","Q0111 - Wet mounts including preparations of vaginal, cervical or skin specimens"]
["S0199","2022-11-30","N","S0199 - medically induced abortion by oral ingestion of medication including all associated services and supplies"]
["S4993","2022-11-30","N","S4993 - Contraceptive pills for bith control"]
["T1015","2022-11-30","Y","T1015 - All inclusive clinic visit code used to identify service provided in a FQHC or Community Health Center."]
["*Reimbursable only to a designated eligible/approved facility.  The CPT code must be billed by the eligible/approved rendering provider, with the 'FP' modifier, and the approved facility must be designated as the billing provider/payee on the claim  "]
[]
["COVID-19 Vaccine & Administration codes"]
["Procedure Code","Coverage Effective Date","Family Planning Diagnosis Required?","End Date, when applicable "]
["0001A","2022-11-30","N","2023-04-18"]
["0002A","2022-11-30","N","2023-04-18"]
["0003A","2022-11-30","N","2023-04-18"]
["0004A","2022-11-30","N","2023-04-18"]
["0011A","2022-11-30","N","2023-04-18"]
["0012A","2022-11-30","N","2023-04-18"]
["0013A","2022-11-30","N","2023-04-18"]
["0031A","2022-11-30","N","2023-05-06"]
["0034A","2022-11-30","N","2023-05-06"]
["0041A","2022-11-30","N","2023-10-31"]
["0042A","2022-11-30","N","2023-10-31"]
["0044A","2022-11-30","N","2023-10-31"]
["0051A","2022-11-30","N","2023-04-18"]
["0052A","2022-11-30","N","2023-04-18"]
["0053A","2022-11-30","N","2023-04-18"]
["0054A","2022-11-30","N","2023-04-18"]
["0064A","2022-11-30","N","2023-04-18"]
["0071A","2022-11-30","N","2023-04-18"]
["0072A","2022-11-30","N","2023-04-18"]
["0073A","2022-11-30","N","2023-04-18"]
["0074A","2022-11-30","N","2023-04-18"]
["0081A","2022-11-30","N","2023-04-18"]
["0082A","2022-11-30","N","2023-04-18"]
["0083A","2022-11-30","N","2023-04-18"]
["0091A","2022-11-30","N","2023-04-18"]
["0092A","2022-11-30","N","2023-04-18"]
["0093A","2022-11-30","N","2023-04-18"]
["0094A","2022-11-30","N","2023-04-18"]
["0111A","2022-11-30","N","2023-04-18"]
["0112A","2022-11-30","N","2023-04-18"]
["0113A","2022-11-30","N","2023-04-18"]
["0121A","2023-04-18","N","2023-09-11"]
["0124A","2022-11-30","N","2023-09-11"]
["0134A","2022-11-30","N","2023-09-11"]
["0141A","2023-04-18","N","2023-09-11"]
["0142A","2023-04-18","N","2023-09-11"]
["0144A","2022-11-30","N","2023-09-11"]
["0154A","2022-11-30","N","2023-09-11"]
["M0201","2022-11-30","N","**12/31/2023"]
["91304","2023-10-03","N"]
["91318","2023-09-11","N"]
["91319","2023-09-11","N"]
["91320","2023-09-11","N"]
["91321","2023-09-11","N"]
["91322","2023-09-11","N"]
["90480","2023-09-11","N","**12/31/2023"]
["**covered for adults age 19+ beyond 12/31/2023 when provider is a Federally Qualified Health Center (FQHC), Rural Health Clinic (RHC), or Encounter Rate Clinic (ERC) and billed FFS separate from a medical encounter. "]
[]
["COVID-19 Vaccine Counseling "]
["Procedure Code","Coverage Effective Date","Family Planning Diagnosis Required?"]
["99402","2022-11-30","N"]