TABLE 6B.

- NEW PROCEDURE CODES

Procedure Description Short Description

Code
047K041 Dilation of Right Femoral Artery with Drug-eluting Intralu- Dilate R Fem Art w Drug-elut In-
minal Device using Drug-Coated Balloon, Open Approach tralum, Drug Blln, Open
047K0D1 Dilation of Right Femoral Artery with Intraluminal Device us- Dilate R Fem Art w Intralum Dev,
ing Drug-Coated Balloon, Open Approach Drug Blln, Open
047K0Z1 Dilation of Right Femoral Artery using Drug-Coated Balloon, Dilation of R Fem Art using Drug
Open Approach Blln, Open Approach
047K341 Dilation of Right Femoral Artery with Drug-eluting Intralu- Dilate R Fem Art w Drug-elut In-
minal Device using Drug-Coated Balloon, Percutaneous Ap- tralum, Drug Blln, Perc
proach
047K3D1 Dilation of Right Femoral Artery with Intraluminal Device us- Dilate R Fem Art w Intralum Dev,
ing Drug-Coated Balloon, Percutaneous Approach Drug Blln, Perc
047K3Z1 Dilation of Right Femoral Artery using Drug-Coated Balloon, Dilation of R Fem Art using Drug
Percutaneous Approach Blln, Perc Approach
047K441 Dilation of Right Femoral Artery with Drug-eluting Intralu- Dilate R Fem Art w Drug-elut In-
minal Device using Drug-Coated Balloon, Percutaneous Endo- tralum, Drug Blln, Perc Endo
scopic Approach
047K4D1 Dilation of Right Femoral Artery with Intraluminal Device us- Dilate R Fem Art w Intralum Dev,
ing Drug-Coated Balloon, Percutaneous Endoscopic Approach Drug Blln, Perc Endo
047K4Z1 Dilation of Right Femoral Artery using Drug-Coated Balloon, Dilation of R Fem Art using Drug
Percutaneous Endoscopic Approach Blln, Perc Endo Approach
047L041 Dilation of Left Femoral Artery with Drug-eluting Intralu- Dilate L Fem Art w Drug-elut In-
minal Device using Drug-Coated Balloon, Open Approach tralum, Drug Blln, Open
047L0D1 Dilation of Left Femoral Artery with Intraluminal Device us- Dilate L Fem Art w Intralum Dev,
ing Drug-Coated Balloon, Open Approach Drug Blln, Open
047L0Z1 Dilation of Left Femoral Artery using Drug-Coated Balloon, Dilation of L Fem Art using Drug
Open Approach Blln, Open Approach
047L341 Dilation of Left Femoral Artery with Drug-eluting Intralu- Dilate L Fem Art w Drug-elut In-
minal Device using Drug-Coated Balloon, Percutaneous Ap- tralum, Drug Blln, Perc
proach
047L3D1 Dilation of Left Femoral Artery with Intraluminal Device us- Dilate L Fem Art w Intralum Dev,
ing Drug-Coated Balloon, Percutaneous Approach Drug Blln, Perc
047L3Z1 Dilation of Left Femoral Artery using Drug-Coated Balloon, Dilation of L Fem Art using Drug
Percutaneous Approach Blln, Perc Approach
047L441 Dilation of Left Femoral Artery with Drug-eluting Intralu- Dilate L Fem Art w Drug-elut In-
minal Device using Drug-Coated Balloon, Percutaneous Endo- tralum, Drug Blln, Perc Endo
scopic Approach
047L4D1 Dilation of Left Femoral Artery with Intraluminal Device us- Dilate L Fem Art w Intralum Dev,
ing Drug-Coated Balloon, Percutaneous Endoscopic Approach Drug Blln, Perc Endo
047L4Z1 Dilation of Left Femoral Artery using Drug-Coated Balloon, Dilation of L Fem Art using Drug
Percutaneous Endoscopic Approach Blln, Perc Endo Approach
047M041 Dilation of Right Popliteal Artery with Drug-eluting Intralu- Dilate R Popl Art w Drug-elut In-
minal Device using Drug-Coated Balloon, Open Approach tralum, Drug Blln, Open
047M0D1 Dilation of Right Popliteal Artery with Intraluminal Device Dilate R Popl Art w Intralum Dev,
using Drug-Coated Balloon, Open Approach Drug Blln, Open
 TABLE 6B. - NEW PROCEDURE CODES

Procedure Description Short Description

Code
047M0Z1 Dilation of Right Popliteal Artery using Drug-Coated Balloon, Dilation of R Popl Art using Drug
Open Approach Blln, Open Approach
047M341 Dilation of Right Popliteal Artery with Drug-eluting Intralu- Dilate R Popl Art w Drug-elut In-
minal Device using Drug-Coated Balloon, Percutaneous Ap- tralum, Drug Blln, Perc
proach
047M3D1 Dilation of Right Popliteal Artery with Intraluminal Device Dilate R Popl Art w Intralum Dev,
using Drug-Coated Balloon, Percutaneous Approach Drug Blln, Perc
047M3Z1 Dilation of Right Popliteal Artery using Drug-Coated Balloon, Dilation of R Popl Art using Drug
Percutaneous Approach Blln, Perc Approach
047M441 Dilation of Right Popliteal Artery with Drug-eluting Intralu- Dilate R Popl Art w Drug-elut In-
minal Device using Drug-Coated Balloon, Percutaneous Endo- tralum, Drug Blln, Perc Endo
scopic Approach
047M4D1 Dilation of Right Popliteal Artery with Intraluminal Device Dilate R Popl Art w Intralum Dev,
using Drug-Coated Balloon, Percutaneous Endoscopic Ap- Drug Blln, Perc Endo
proach
047M4Z1 Dilation of Right Popliteal Artery using Drug-Coated Balloon, Dilation of R Popl Art using Drug
Percutaneous Endoscopic Approach Blln, Perc Endo Approach
047N041 Dilation of Left Popliteal Artery with Drug-eluting Intralu- Dilate L Popl Art w Drug-elut In-
minal Device using Drug-Coated Balloon, Open Approach tralum, Drug Blln, Open
047N0D1 Dilation of Left Popliteal Artery with Intraluminal Device us- Dilate L Popl Art w Intralum Dev,
ing Drug-Coated Balloon, Open Approach Drug Blln, Open
047N0Z1 Dilation of Left Popliteal Artery using Drug-Coated Balloon, Dilation of L Popl Art using Drug
Open Approach Blln, Open Approach
047N341 Dilation of Left Popliteal Artery with Drug-eluting Intralu- Dilate L Popl Art w Drug-elut In-
minal Device using Drug-Coated Balloon, Percutaneous Ap- tralum, Drug Blln, Perc
proach
047N3D1 Dilation of Left Popliteal Artery with Intraluminal Device us- Dilate L Popl Art w Intralum Dev,
ing Drug-Coated Balloon, Percutaneous Approach Drug Blln, Perc
047N3Z1 Dilation of Left Popliteal Artery using Drug-Coated Balloon, Dilation of L Popl Art using Drug
Percutaneous Approach Blln, Perc Approach
047N441 Dilation of Left Popliteal Artery with Drug-eluting Intralu- Dilate L Popl Art w Drug-elut In-
minal Device using Drug-Coated Balloon, Percutaneous Endo- tralum, Drug Blln, Perc Endo
scopic Approach
047N4D1 Dilation of Left Popliteal Artery with Intraluminal Device us- Dilate L Popl Art w Intralum Dev,
ing Drug-Coated Balloon, Percutaneous Endoscopic Approach Drug Blln, Perc Endo
047N4Z1 Dilation of Left Popliteal Artery using Drug-Coated Balloon, Dilation of L Popl Art using Drug
Percutaneous Endoscopic Approach Blln, Perc Endo Approach
X2C0361* Extirpation of Matter from Coronary Artery, One Site using Extirpate matter from 1 Cor Art,
Orbital Atherectomy Technology, Percutaneous Approach, Orbit Athrect, New Tech 1
New Technology Group 1
X2C1361* Extirpation of Matter from Coronary Artery, Two Sites using Extirpate matter from 2 Cor Art,
Orbital Atherectomy Technology, Percutaneous Approach, Orbit Athrect, New Tech 1
New Technology Group 1
X2C2361* Extirpation of Matter from Coronary Artery, Three Sites using Extirpate matter from 3 Cor Art,
 TABLE 6B. - NEW PROCEDURE CODES

Procedure Description Short Description

Code
Orbital Atherectomy Technology, Percutaneous Approach, Orbit Athrect, New Tech 1
New Technology Group 1
X2C3361* Extirpation of Matter from Coronary Artery, Four or More Extirpate matter from 4+ Cor Art,
Sites using Orbital Atherectomy Technology, Percutaneous Orbit Athrect, New Tech 1
Approach, New Technology Group 1
XR2G021* Monitoring of Right Knee Joint using Intraoperative Knee Re- Monitor R Knee Jt w Intraop Knee
placement Sensor, Open Approach, New Technology Group 1 Sens, Open, New Tech 1
XR2H021* Monitoring of Left Knee Joint using Intraoperative Knee Re- Monitor L Knee Jt w Intraop Knee
placement Sensor, Open Approach, New Technology Group 1 Sens, Open, New Tech 1
XW03321 Introduction of Ceftazidime-Avibactam Anti-infective into Pe- Introduce Ceftazidime in Periph
ripheral Vein, Percutaneous Approach, New Technology Vein, Perc, New Tech 1
Group 1
XW03331* Introduction of Idarucizumab, Dabigatran Reversal Agent into Introduce Idarucizumab in Periph
Peripheral Vein, Percutaneous Approach, New Technology Vein, Perc, New Tech 1
Group 1
XW03341* Introduction of Isavuconazole Anti-infective into Peripheral Introduce Isavuconazole in Periph
Vein, Percutaneous Approach, New Technology Group 1 Vein, Perc, New Tech 1
XW03351* Introduction of Blinatumomab Antineoplastic Immunotherapy Introduce Blinatumomab in Periph
into Peripheral Vein, Percutaneous Approach, New Technolo- Vein, Perc, New Tech 1
gy Group 1
XW04321 Introduction of Ceftazidime-Avibactam Anti-infective into Introduce Ceftazidime in Central
Central Vein, Percutaneous Approach, New Technology Vein, Perc, New Tech 1
Group 1
XW04331* Introduction of Idarucizumab, Dabigatran Reversal Agent into Introduce Idarucizumab in Central
Central Vein, Percutaneous Approach, New Technology Vein, Perc, New Tech 1
Group 1
XW04341* Introduction of Isavuconazole Anti-infective into Central Vein, Introduce Isavuconazole in Central
Percutaneous Approach, New Technology Group 1 Vein, Perc, New Tech 1
XW04351* Introduction of Blinatumomab Antineoplastic Immunotherapy Introduce Blinatumomab in Central
into Central Vein, Percutaneous Approach, New Technology Vein, Perc, New Tech 1
Group 1
Notes:
*
These procedure codes were discussed at the March 18, 2015 - March 19, 2015 Coordination
and Maintenance Committee meeting and were not finalized in time to include in the proposed
rule. They will be implemented on October 1, 2015.