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0195T - instrumentation, with image guidance, includes bone graft when performed; L5-S1 interspace

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Procedure / Serviceinstrumentation, with image guidance, includes bone graft when performed; L5-S1 interspace
Procedure / Service Description

Arthrodesis, pre-sacral interbody technique, disc space preparation, discectomy, without - 01942 kyphoplasty, vertebroplasty) on the spine or spinal cord; lumbar or sacral Arthrodesis, pre-sacral interbody technique, disc space preparation, discectomy, without 0195T instrumentation, with image guidance, includes bone graft when performed; L5-S1 interspace Intra-fraction localization and tracking of target or patient motion during delivery of radiation 0197T therapy (eg, 3D positional tracking, gating, 3D surface tracking), each fraction of treatment

Likely documents
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Next actions
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  • Use the insurer authorization workflow for this listed code.